Development of hyperacute high-output heart failure at access creation

High-output heart failure can occur in patients undergoing hemodialysis via permanent access. We have described two cases of hyperacute high-output heart failure. Two patients with multiple previous failed access attempts presented for redo access. Each patient experienced high-output heart failure in the operating room during access placement. A delay in the diagnosis led to the first patient's death, although early recognition led to successful treatment of the second patient. Hyperacute heart failure during access creation is uncommon. Early recognition of this complication is important because timely intervention can be life-saving.