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[Cardiac surgery for chronic dialysis patients]
H Minami1, M Kuinose, T Murakami
1Department of Cardiovascular Surgery, Iwakuni National Hospital, Iwakuni, Japan.
Insights
This study shows that chronic dialysis patients can safely undergo open heart surgery with careful perioperative management, including intraoperative hemodialysis. All patients were discharged in good condition, demonstrating the feasibility of these complex procedures.
Area of Science:
- Cardiology
- Nephrology
- Surgical Management
Context:
- Open heart surgery in chronic dialysis patients presents unique perioperative management challenges.
- Managing fluid balance, electrolytes, and anticoagulation is critical for this patient population.
- Previous literature on this specific surgical cohort and management strategies is limited.
Purpose:
- To evaluate the perioperative management and outcomes of chronic dialysis patients undergoing open heart surgery.
- To assess the safety and efficacy of intraoperative hemodialysis in this high-risk group.
- To report on postoperative complications and recovery trajectories.
Summary:
- Twelve chronic dialysis patients underwent various open heart surgeries (CABG, AVR, MVR, ascending aorta replacement) between 1990 and 2000.
- Perioperative management included pre-operative dialysis, intraoperative hemodialysis (HD) via the cardiopulmonary system, and delayed post-operative HD.
- No hospital deaths occurred; one patient experienced sternal mediastinitis. All patients were discharged in good condition after an average of 27.1 days.
Impact:
- Demonstrates the successful surgical management of chronic dialysis patients requiring open heart procedures.
- Highlights the potential benefits of intraoperative hemodialysis in mitigating perioperative complications.
- Provides valuable data for optimizing anesthetic and surgical protocols for this vulnerable patient group.
Abstract:
Chronic dialysis patients who received open heart surgery were examined, and main concern was perioperative management. There were 12 chronic dialysis patients and open heart surgeries were performed between October 1990 and June 2000. The patients were comprised of 7 men and 5 women with the average age being 64 with plus or minus 7.9. The operative procedure of 6 coronary artery bypass grafting (CABG) [on-pump], 1 CABG + mitral valve replacement (MVR), 3 aortic valve replacement (AVR), 1 mitral valvuloplasty (MVP) and 1 ascending aorta replacement were performed. All patients were discharged from the hospital with good conditions 27.1 days after operation. There were no hospital deaths. One postoperative complication of mediastinitis of the sternum has been found. A conventional dialysis was performed the day before the operation and an intra-operative hemodialysis (HD) was performed, placing a dialyzer into a cardiopulmonary system during the operation. For the perioperative management, HD was started the day or 2 days after the operation with no immediate postoperative hemocatharsis and returned to the normal HD 7 days after the operation. The result of the perioperative management has been good.