[Cardiac surgery in chronic hemodialysed patients: immediate and long-term results].
Between 1979 and 1993, 50 patients (33 men and 17 women) receiving chronic haemodialysis, underwent 53 cardiac surgical procedures in the department. The mean age was 56 +/- 13 years. The average duration of preoperative dialysis was 82 +/- 63 months. The average duration of cardiac symptoms before surgery was 35 +/- 52 months. Twenty-seven patients (54%) were in NYHA functional classes III or IV before surgery. Sixteen patients (32%) had preoperative left ventricular ejection fractions of less than 0.40. Twelve patients (24%) were emergency referrals. Twenty-nine patients underwent isolated coronary bypass surgery, 13 patients underwent isolated aortic valvular replacement which had to be repeated in one case, 3 patients underwent mitral valve replacement, which had to be repeated in 2 cases, and 5 patients underwent combined surgery. The average aortic clamping time was 75 +/- 32 minutes, the average cardio-pulmonary bypass time was 125 +/- 50 minutes. The surgical revascularisation of the coronary patients was incomplete in 37% of cases because of the severity of the underlying coronary artery disease. The average postoperative bleeding was 800 +/- 650 ml; 29 patients (58%) were transfused with an average of 4.3 +/- 3 units of blood. The global early mortality was 9 patients (18%); 10% in coronary bypass, 7% in aortic valve replacement and 50% in patients with more complex procedures. The causes of death were cardiac (n = 4), sepsis (n = 2) and multiple organ failure (n = 3). The morbidity was 39%, mainly due to low cardiac output.(ABSTRACT TRUNCATED AT 250 WORDS)
Deleuze
P H
PH
Service de chirurgie thoracique et cardiovasculaire, hôpital Henri-Mondor, Créteil.
Mazzucotelli
J P
JP
Maillet
J M
JM
Le Besnerais
P
P
Mourtada
A
A
Hillion
M L
ML
Loisance
D Y
DY
Cachera
J P
JP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery*; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis; D013997:Time Factors
Chirurgie cardiaque chez l'hémodialysé chronique: résultats immédiats et à long terme.