title: Cardiac surgery in the presence of dialysis: effect on mid-term outcomes and quality of life.
abstract: BACKGROUND
  this study evaluates the impact on short and mid-term outcomes and quality of life of dialysis dependent patients undergoing cardiac surgery. The benefit to patients from a bio-psycho-social perspective is put into context via an inter-personal patient interview.
  
  
  METHODS
  the study period was from February 1999 to February 2009. Data on 45 dialysis dependent patients undergoing cardiac surgery was prospectively collected and analysed retrospectively. The mean age was 59.9 years and sex ratio (M:F) of 32:13. All patients were New York Heart Association (NYHA) class >2 preoperatively. Fifty-five percent (25/45) of these patients had coronary artery bypass graft surgery (CABG) and 28% (12/45) aortic valve replacement surgery alone. Forty-two variables were studied to define predictors of outcome. Follow-up was 100% (18/18) with a mean follow-up time of 48.1 months (0-124 months). They were followed up with quality of life and functional coping score surveys (SF-36).
  
  
  RESULTS
  the main postoperative morbidities were pulmonary complications 20% (9/45), multi-organ failure 11% (5/45) and blood transfusion rates 40% (18/45). The 30 day mortality of the dialysis patients was 13.3% (6/45) and late death was 54% (21/39). Increasing age, pulmonary complications and blood product usage were the significant predictors of both 30 day mortality (age: p=0.02, pulmonary: p=0.003, blood product usage: p=0.03) and late death (age: p=0.008, pulmonary: p=0.02, blood product usage: p=0.02). New York Heart Association class was I-II in 83% (15/18) on long term follow up. All five patients awaiting renal transplants received their transplant in the first six months post-operatively. The overall survival at one year was 78% and five years was 40%. On SF-36 health questionnaire all patients scored less on physical functioning than the Australian norms (24.89 ± 4.10).
  
  
  CONCLUSIONS
  cardiac surgery in the presence of renal failure is associated with significant morbidity and mortality. The overall survival and quality of life of dialysis patients undergoing cardiac surgery is poor.
authors.affiliation: Department of Cardiothoracic Surgery, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD 4000, Australia.
authors.forename: Hasanga
authors.initials: H
authors.lastname: Jayasekera
authors.forename: Nigel
authors.initials: N
authors.lastname: Pinto
authors.forename: Julie
authors.initials: J
authors.lastname: Mundy
authors.forename: Annabel
authors.initials: A
authors.lastname: Wood
authors.forename: Elaine
authors.initials: E
authors.lastname: Beller
authors.forename: Rayleene
authors.initials: R
authors.lastname: Griffin
authors.forename: Paul
authors.initials: P
authors.lastname: Peters
authors.forename: Pallav
authors.initials: P
authors.lastname: Shah
mesh_terms: D001021:Aortic Valve / Q000601:surgery; D001026:Coronary Artery Bypass; D018572:Disease-Free Survival; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors