Open heart surgery in patients with dialysis-dependent renal insufficiency.
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
Open-heart 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.
Gelsomino
S
S
Department of Cardiovascular Sciences, General Hospital S. Maria Della Misericordia, Udine, Italy. sandrogelsomino@virgilio.it
Morocutti
G
G
Masullo
G
G
Cheli
G
G
Poldini
F
F
Da Broi
U
U
Livi
U
U
D000206:Actuarial Analysis; D001026:Coronary Artery Bypass / Q000401:mortality; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies