title: Early and Late Outcomes of Thoracic Aortic Surgery in Hemodialysis Patients.
abstract: BACKGROUND
  The number of cardiovascular surgeries among hemodialysis patients is increasing according to the growing population of hemodialysis patients; however, the clinical outcome has not yet been clarified, especially in thoracic aortic surgery. The purpose of this study was to assess the early and late outcomes of thoracic aortic surgery in hemodialysis patients.
  
  
  METHODS
  We retrospectively analyzed the outcomes of 700 consecutive open thoracic aortic surgeries from 2002 to 2014. We identified 21 patients receiving preoperative hemodialysis (group HD) and 679 patients not receiving preoperative hemodialysis (group N). The patients were predominantly male, had diabetes mellitus and cardiogenic shock, and had less hyperlipidemia and elective surgery in group HD. The early and late outcomes were compared between 21 patients in each group using a propensity-score matched analysis.
  
  
  RESULTS
  The hospital stay and intensive care unit stay were significantly longer in group HD even after matching. The 30-day mortality and inhospital mortality showed no significant differences, whereas the rate of postoperative pneumonia was significantly higher in group HD compared with the matched group N (p = 0.0067). The 1-year, 3-year, and 7-year survival rates in group HD were 73.4%, 45.7%, and 30.5%, respectively, which were significantly poorer than that of group N both in the prematched (p < 0.001) and matched analyses (p = 0.0027).
  
  
  CONCLUSIONS
  Considering the various operative risks associated with hemodialysis patients, the early mortality rate is acceptable, even after the association with many respiratory complications. Although hemodialysis patients have a compromised prognosis after surgery, excessive hesitation to perform thoracic aortic surgery may be avoided.
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. Electronic address: mhibino-ngy@umin.org.
authors.forename: Makoto
authors.initials: M
authors.lastname: Hibino
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Oshima
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Narita
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Tomonobu
authors.initials: T
authors.lastname: Abe
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Mutsuga
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Kazuro L
authors.initials: KL
authors.lastname: Fujimoto
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Tokuda
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Sachie
authors.initials: S
authors.lastname: Terazawa
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ito
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Usui
mesh_terms: D000328:Adult; D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality* / Q000601:surgery*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D057216:Propensity Score; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D019616:Thoracic Surgical Procedures / Q000379:methods / Q000401:mortality*; D013997:Time Factors; D016896:Treatment Outcome