Open heart surgery in patients with end-stage renal failure: fifteen-year experience

Area of Science:

• Cardiology
• Nephrology
• Cardiac Surgery

Background:

• Patients with end-stage renal failure requiring hemodialysis represent a growing population undergoing cardiac surgery.
• Assessing the risks and outcomes of cardiopulmonary bypass (CPB) in this specific patient group is crucial for surgical planning and patient management.

Purpose of the Study:

• To evaluate the risk factors and outcomes of cardiac surgery utilizing cardiopulmonary bypass (CPB) in patients dependent on hemodialysis.
• To compare the perioperative findings and survival rates between hemodialysis-dependent patients and those with normal renal function.

Main Methods:

• A retrospective analysis of 16,425 patients undergoing open heart surgery with CPB between 1991 and 2006.
• Identification of 91 patients (0.6%) with hemodialysis-dependent end-stage renal failure (HDRF group) and comparison with a control group of patients with normal renal function.
• Evaluation of preoperative, operative, and postoperative data, including survival analyses for the HDRF group.

Main Results:

• The HDRF group underwent various cardiac procedures, including coronary artery, valve, and aortic surgeries.
• Cardiopulmonary bypass and aortic cross-clamping times were significantly longer in the HDRF group.
• While early mortality was slightly higher in the HDRF group (7.7% vs. 4.8%), there were no significant differences in reoperations, infections, or major systemic complications. Actuarial survival rates at 1, 5, and 10 years were 86%, 20%, and 6.8% respectively for HDRF survivors.

Conclusions:

• Open heart surgery in hemodialysis patients is associated with increased risks.
• However, with an effective hemodialysis program, these patients can undergo surgery with acceptable operative complications and mortality.
• This study highlights the feasibility of cardiac surgery in end-stage renal failure patients when managed appropriately.