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[Hemodialysis Patients in Cardiovascular Surgery;Current Status and Management]

Noboru Motomura1

  • 1Department of Cardiovascular Surgery, Toho University Sakura Medical Center, Sakura, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|November 1, 2020
PubMed

Insights

Cardiovascular surgery poses significant risks for dialysis patients, with higher operative mortality in coronary artery bypass grafting. Careful fluid management is crucial before and after procedures to ensure patient stability and prevent complications like non-occlusive mesenteric ischemia.

Area of Science:

  • Cardiovascular Surgery
  • Nephrology
  • Critical Care Medicine

Background:

  • Cardiovascular surgery in patients with end-stage renal disease requiring dialysis presents unique challenges and increased risks.
  • Dialysis patients constitute a significant portion of patients undergoing major cardiovascular procedures, including coronary artery bypass grafting (CABG) and aortic valve replacement (AVR).
  • Existing data highlights disparities in outcomes between dialysis and non-dialysis populations undergoing these surgeries.

Purpose of the Study:

  • To analyze the outcomes and surgical practices for dialysis patients undergoing cardiovascular surgery in Japan.
  • To compare the operative mortality and procedural choices between dialysis and non-dialysis patients for CABG and AVR.
  • To identify critical perioperative management strategies for dialysis patients undergoing cardiovascular surgery.

Main Methods:

  • Utilized the Japan Cardiovascular Surgery Database (JCVSD) to identify and analyze data on patients undergoing CABG and AVR.
  • Compared procedural data, including off-pump CABG rates and bioprosthetic valve use in aortic valve replacement, between dialysis and non-dialysis cohorts.
  • Examined operative mortality rates for both groups.

Main Results:

  • Dialysis patients represented approximately 10% of CABG and 9% of AVR procedures in the analyzed Japanese cohort.
  • Operative mortality for dialysis patients undergoing CABG was 7.8%, which is three times higher than the 2.1% observed in non-dialysis patients.
  • The use of bioprosthetic valves in AVR was common (65%) among dialysis patients, particularly those over 70, mirroring trends in non-dialysis patients.

Conclusions:

  • Cardiovascular surgery in dialysis patients is associated with significantly higher operative mortality compared to non-dialysis patients.
  • Perioperative fluid management is critical; avoiding excessive dehydration before surgery is essential for hemodynamic stability, and preventing dehydration post-surgery is vital to avoid non-occlusive mesenteric ischemia (NOMI).
  • Further research and optimized clinical protocols are needed to improve outcomes for this high-risk patient population.

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