Introduction. Patients on dialysis for end-stage renal failure are subjected
to cardiac surgery with increasing frequency. End-stage renal failure is
known to be an important risk factor for complications of cardiac operations
performed with cardiopulmonary bypass. The aim of this study was to determine
the impact of preoperative clinical status and operative variables on
perioperative morbidity and mortality in hemodialysis dependent patients
subjected to a cardiac surgery. Material and Methods. The following operative
variables were examined: urgency, type and duration of surgery and duration
of extracorporeal circulation. The study is a retrospective analysis of
consecutive patients with end-stage renal failure dependent on maintenance
hemodialysis who underwent cardiac surgery during four years. Results. The
study included 46 patients. Operations performed included isolated coronary
artery bypass grafting (CABG, n = 24), valve surgery alone (n = 6), and
combined valve surgery or coronary artery bypass grafting and valve surgery
(n = 16). The perioperative mortality rate was 13% with four fatal outcomes
in patients who had undergone combined cardiac surgery. We found age > 70
years, preoperative New York Heart Association class IV, preoperative anemia,
combined surgery and emergent surgery to be associated with a higher relative
risk for perioperative death. Conclusion. Patients on dialysis have an
increased morbidity and mortality following cardiac surgery; however, we
believe that end-stage renal failure should not be regarded as a
contraindication to cardiac surgery or cardiopulmonary bypass.
Heart surgery in patients on chronic dialysis
