Midterm results of surgical treatment of thoracic aortic disease in dialysis patients.
BACKGROUND
We investigated the influence of dialysis on late aortic events in end-stage renal failure patients who had undergone replacement of the thoracic aorta.


METHODS
Between 1990 and 2003, 28 dialysis patients underwent thoracic aortic aneurysm repair. The cause was non-dissection in 17 patients and dissection in 11 patients. Six patients needed emergency operations. After the initial operation, 10 patients in the dialysis group had a patent false channel distal to the operative area, and 7 patients in the dialysis group had untreated separate aneurysms. These lesions were defined as residual aneurysms. We performed a retrospective case-control analysis of survival and late aortic events (enlargement of the remaining thoracic aorta, sudden death and reoperation) in dialysis patients versus carefully matched non-dialysis patients. Matching criteria included age, sex, cause, operative procedures, operative date, and operative status (elective or emergency).


RESULTS
Survival rates at 1 and 5 years for dialysis patients versus non-dialysis patients were 63 +/- 9% vs. 85 +/- 7% and 41 +/- 11% versus 64 +/- 13%, respectively (p = 0.02). Four of nine late deaths in the dialysis group were due to rupture of residual aneurysm. Freedom from late aortic events for dialysis patients versus non-dialysis patients was 91+/- 6% versus 92 +/- 5% and 25 +/- 14% versus 68 +/- 12% at 1 and 5 years, respectively (p = 0.0073).


CONCLUSIONS
There is a high incidence of late aortic events in dialysis patients undergoing thoracic aortic aneurysm repair. This finding indicates the need for close follow-up examination of dialysis patients who have undergone surgical treatment of thoracic aortic disease.
Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan. kmori@sapmed.ac.jp
Kiyofumi
K
Morishita
Nobuyoshi
N
Kawaharada
Johji
J
Fukada
Yoshihiko
Y
Kurimoto
Yasuaki
Y
Fujisawa
Tatsuya
T
Saito
Tomio
T
Abe
D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome