Cardiac surgery in patients with dialysis-dependent renal disease.
This study was designed to evaluate the operative outcome of dialysis patients undergoing cardiac surgery. A retrospective review was performed of 28 consecutive patients with end-stage renal disease dependent on maintenance hemodialysis (n = 26) or peritoneal dialysis (n = 2) who underwent cardiopulmonary bypass (CPB). The operations included isolated coronary artery bypass grafting (CABG) (n = 21), aortic valve replacement (n = 4) and CABG plus aortic valve replacement (n = 3). Seven operations were emergent or urgent. In 23 patients, a heparin-coated (HC) circuit with reduced systemic heparinization was used for CPB. The hospital mortality was 7.1%. Complications occurred in 13 patients (46%). Although thoracotomy for bleeding was required in 3 patients, only 1 had undergone CPB with an HC circuit. There were 7 late deaths. All survivors showed improvement in symptoms and overall functional status. The actuarial survival rates were 78% and 58% at 1 and 4 years, respectively. In the 10 patients with diabetes mellitus, the 4-year survival rate was 50%. In the patients who underwent non-elective surgery, the survival rate was 29%. Cardiac surgery can be performed with increased but acceptable mortality in dialysis patients. Good symptomatic relief can be expected. Surgery should be performed before the general condition deteriorates.
Suehiro
S
S
Osaka City University Medical School, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585.
Shibata
T
T
Sasaki
Y
Y
Murakami
T
T
Hosono
M
M
Fujii
H
H
Kinoshita
H
H
D000206:Actuarial Analysis; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D001021:Aortic Valve / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000145:classification; D002315:Cardiopulmonary Bypass; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D048909:Diabetes Complications; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D019106:Postoperative Hemorrhage / Q000601:surgery; D006435:Renal Dialysis; D012189:Retrospective Studies; D015996:Survival Rate; D013908:Thoracotomy; D016896:Treatment Outcome
D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; D006493:Heparin