title: "Blame it on the Comorbidities": A 5-Year Follow-Up of 53 Chronic Dialysis-Dependent Patients Who Underwent Cardiac Surgery.
abstract: ObjectivesThis study evaluates midterm survival rates and risk factors for mortality of chronic dialysis-dependent patients undergoing cardiac surgery.MethodsFifty-three dialysis-dependent patients (34 males, aged 67 ± 12 years) with end-stage renal disease operated within March 2007 and May 2012 were analyzed retrospectively. Survival rates were calculated using Kaplan-Meier methods. Predictors of midterm survival were identified with multivariate Cox-regression analysis.ResultsTwenty-three patients received isolated coronary artery bypass graft surgery, 17 received isolated valve replacement, and 13 received combined procedures. Thirty-day mortality was 24.5% (n= 13). Follow-up was complete for 94.3% (n= 50). Survival rates at 1, 3, and 5 years were: 82, 50, and 17%, respectively. Neither age, gender, poor ejection fraction, emergency, ECC/X-clamp (cross-clamp) time, nor use of left internal thoracic artery or right internal thoracic artery had any influence on midterm survival. Causes of death within midterm follow-up period were related to cardiac events in 16% and neurological events in 16%. In the majority (47%), cause of death was associated with peripheral arterial disease (PAD).The only comorbidity, which could be identified as a significant risk factor, was PAD (p= 0.035). Five patients underwent successful renal transplantation within the follow-up period.ConclusionAlthough 30-day mortality in this high-risk patient population was increased, midterm survival rates were comparable to the results described in the literature. Cause of death within midterm follow-up period was mostly noncardiac related. Given the limited number of patients, predictors for enhanced 30-day mortality, such as preoperative myocardial infarction, prolonged extracorporeal circulation, operation time, and diabetes mellitus, did not have an influence on midterm survival.
authors.affiliation: Department of Cardiac Surgery, Klinikum Bogenhausen, Munich, Bavaria, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Deutsch
authors.affiliation: Department of Cardiac Surgery, Klinikum Bogenhausen, Munich, Bavaria, Germany.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Rippinger
authors.affiliation: Department of Cardiac Surgery, University Thessaly, Larisa, Greece.
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Spiliopoulos
authors.affiliation: Department of Cardiac Surgery, Klinikum Bogenhausen, Munich, Bavaria, Germany.
authors.forename: Walter
authors.initials: W
authors.lastname: Eichinger
authors.affiliation: Department of Cardiac Surgery, Klinikum Bogenhausen, Munich, Bavaria, Germany.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Gansera
mesh_terms: D000368:Aged; D002423:Cause of Death; D016009:Chi-Square Distribution; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome