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Open Heart Surgery in Patients with Dialysis‐dependent Renal Insufficiency
Author(s) -
Gelsomino Sandro,
Morocutti Giorgio,
Masullo Gianluca,
Cheli Gianpietro,
Poldini Fulvio,
Broi Ugo,
Livi Ugolino
Publication year - 2001
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.2001.tb00541.x
Subject(s) - medicine , dialysis , hemodialysis , peritoneal dialysis , perioperative , ejection fraction , surgery , heart failure , renal replacement therapy , population , cardiology , coronary artery disease , cardiac surgery , kidney disease , risk factor , environmental health
Objective: Chronic renal failure (CRF) is commonly considered a significant factor for increased morbidity and mortality after cardiac surgery. Methods: To assess the risk in our population we retrospectively analyzed 28 patients (16 men and 12 women, mean age 58.1 ± 10.8 years) with end‐stage renal disease (ESRD) undergoing cardiac surgery between 1989 and 2001. Sixteen (57.2%) patients had isolated coronary artery bypass grafting (CABG), nine (32.1%) had isolated valve replacement, and three (10.7%) underwent combined CABG and valve replacement. Preoperatively, 20 (71.4%) patients were on hemodialysis and eight (28.6%) on peritoneal dialysis. Mean preoperative duration of dialysis was 38.7 ± 24.9 months (range, 3 to 93 months). Results: There were two perioperative deaths (30‐day mortality, 7.1%). Actuarial survival at 1, 2, 5, and 12 years was 0.85 ± 0.7, 0.73 ± 0.10, 0.65 ± 0. 12, and 0.54 ± 0.14, respectively. Among 22 survivors, mean NYHA class was 1.7 ± 0.8 (p > 0.001 vs. preoperatively) and mean CCS class was 1.6 ± 0.6 (p > 0.001 vs. preoperatively). CCS/NYHA functional class IV (p = 0.01), urgent/emergency operation (p > 0.001), LVEF > 35% (p > 0.001) were strongly related to early and late mortality. Conclusions: Openheart operations can be performed with acceptable short‐ and long‐term results in patients with CRF on dialysis. Adequate preoperative management with identification of high‐risk patients and a more aggressive approach before the onset of symptoms of cardiac failure are advisable.