title: Open heart surgery in patients with end-stage renal failure: fifteen-year experience.
abstract: OBJECTIVE
  Risk factors and results of cardiac surgery with cardiopulmonary bypass (CPB) in hemodialysis-dependent renal failure patients at our center were evaluated.
  
  
  METHODS
  Out of 16,425 patients undergoing open heart surgery with CPB at our center between January 1991 and April 2006, 91 (0.6%) experienced hemodialysis-dependent end-stage renal failure. Preoperative, operative, and postoperative findings of two groups of patients were evaluated: those with normal renal function (control group) and those with chronic renal failure undergoing regular hemodialysis (HDRF group). Survival analyses of the hemodialysis group of patients were performed.
  
  
  RESULTS
  In the hemodialysis group, 54 (59.3%) patients underwent coronary artery surgery, 31 (34.1%) patients had valve surgery, four (4.4%) patients had aortic surgery, and two others (2.2%) experienced concomitant coronary and peripheral artery surgery. CPB and aortic cross-clamping (ACC) times were longer in the HDRF group (p=0.000 and 0.002, respectively). There was no significant difference between the two groups with regard to either reoperations, infections, pulmonary and gastrointestinal system complications, or cerebrovascular event parameters (p=0.167, 0.341, 1.000, 1.000, and 1.000, respectively). There was no difference between groups in the postoperative development of low cardiac output (p=0.398). The early mortality rate was 7.7% (seven patients) in the HDRF group and 4.8% (780 patients) in the controls (p=0.211). The actuarial survival rates in HDRF survivors at one, two, three, four, five, and ten years were overall 86%, 80%, 68.1%, 45.4%, 20%, and 6.8%, respectively.
  
  
  CONCLUSIONS
  Open heart surgery in hemodialysis patients is associated with a higher incidence of risks, but can be performed with acceptable operative complications and mortality with an effective hemodialysis program.
authors.affiliation: Department of Cardiovascular Surgery, Türkiye Yuksek Ihtisas Hospital, Ankara, Turkey.
authors.forename: Ilknur
authors.initials: I
authors.lastname: Bahar
authors.forename: Ahmet
authors.initials: A
authors.lastname: Akgul
authors.forename: Ali E
authors.initials: AE
authors.lastname: Demirbag
authors.forename: Levent
authors.initials: L
authors.lastname: Altinay
authors.forename: Larry O
authors.initials: LO
authors.lastname: Thompson
authors.forename: Mediha
authors.initials: M
authors.lastname: Boran
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Ozatik
authors.forename: Levent
authors.initials: L
authors.lastname: Birincioglu
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014421:Turkey / Q000453:epidemiology