Cardiovascular surgery in patients on chronic dialysis: effect of intraoperative hemodialysis

To evaluate the operative result and the perioperative management of dialysis patients undergoing elective cardiac surgery, we retrospectively reviewed consecutive adult patients with chronic renal failure dependent on maintenance dialysis. Between April 1994 and March 2002, 20 patients who underwent cardiopulmonary bypass (CPB) procedures were studied. Fourteen patients underwent isolated coronary artery bypass grafting, four valve replacements and two combined procedures. Our strategy for the chronic dialysis patients was as follows: dialysis the day before the operation, intraoperative hemodialysis (HD) during CPB, and no dialysis or hemofiltration (HF) on the operative day. Intraoperative HD produces the optimal fluid and electrolyte balance at the end of the operation. The mean interval between the end of surgery and the commencement of HD was 31.2+/-12.5 h. No patients required any hemocatharsis such as HF or HD on the day of operation. The overall operative mortality was 5.0%. There were six late deaths (30.0%). Overall, including the operative and non-cardiac death, actuarial survival rate was 85.0% at 1 year, 70.0% at 5 years, and 65.0% at 6 years. Intraoperative HD has an advantage in the postoperative period; it avoids the hemodynamic instability and the risk of heparin-associated bleeding associated with the use of HD.