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Early results and characteristic problems associated with cardiac surgery in long-term dialysis patients
1Department of Cardiovascular Surgery, Kumamoto Central Hospital, Kumamoto, Japan.
Insights
Cardiac surgery in dialysis patients shows acceptable results despite long-term dialysis being a risk factor. These patients should not be denied necessary cardiac procedures.
Area of Science:
- Cardiology
- Nephrology
- Surgical Outcomes
Background:
- Patients on maintenance dialysis present unique challenges for cardiac surgery.
- Understanding early outcomes and complications is crucial for managing this high-risk group.
Purpose of the Study:
- To analyze the early results and characteristic problems following cardiac surgery in patients undergoing maintenance dialysis.
- To assess the safety and efficacy of cardiac surgical interventions in patients with end-stage renal disease.
Main Methods:
- A cohort of 114 patients on maintenance dialysis underwent cardiac surgery.
- Data collected included patient demographics, causes of renal failure, dialysis duration, surgical procedures (isolated coronary artery bypass grafting and combined procedures), and operative details.
- Ascending aorta calcification and hospital mortality were analyzed.
Main Results:
- The study included 114 dialysis patients (mean age 63.5 years, 76% male) with diabetes or glomerulonephritis as primary causes of renal failure.
- Hospital mortality was 8.8% overall (10/114), with 7% in isolated coronary artery bypass grafting (CABG) patients (6/86).
- Severe aortic calcification was noted in 14% of isolated CABG patients, with a significantly higher calcification score compared to controls.
Conclusions:
- Long-term dialysis is a significant risk factor for cardiac surgery.
- Despite the risks, acceptable surgical results indicate that patients on long-term dialysis should not be excluded from cardiac surgery.
- Careful patient selection and management are essential for optimizing outcomes in this population.
Objective(S):
To analyze early results and characteristic problems that develop after cardiac surgery on dialysis patients.
Methods:
One hundred fourteen patients on maintenance dialysis underwent cardiac surgery. Their mean age was 63.5 +/- 9.7 years, and 87 (76%) were male. The causes of chronic renal failure were diabetes mellitus in 41 (36%) and chronic glomerulonephritis in 40 (35%). Patients had previously been on dialysis for a mean duration of 7.8 +/- 5.6 years (range; 0.25-24 years).
Results:
Fourteen (12%) were emergent cases. Eighty six patients (75%) received isolated coronary artery bypass grafting (CABG), and 10 patients underwent operations in which CABG was combined with other cardiac procedures. Twelve patients (14%) of the isolated CABG patient group (86 patients) were restricted to non-clamping bypass procedure due to severe calcification of the ascending aorta. Calcification score, which was represented by the sum of all involved coronary artery segments, was also significantly higher in dialysis patients than in the control group (4.5 +/- 2.4 segments vs. 1.5 +/- 2.1 segments, p < 0.05). Hospital mortality was 8.8% (10/114) overall, and 7% (6/86) in isolated CABG patients. The causes of deaths were as follows: intestinal necrosis in 3, arrhythmia in 2, cerebral infarction in 1, low output syndrome in 1, and sepsis in 3 (mediastinitis, pneumonia, and prosthetic valve infection).
Conclusions:
Long-term dialysis is a major risk factor in cardiac surgery. However, because the surgical results proved to be acceptable, long-term dialysis patients should not be denied cardiac surgery.