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[Heart surgery with extracorporeal circulation in long-term hemodialysis patients]
Insights
Chronic dialysis patients with correctable heart disease can undergo successful cardiac surgery. These interventions do not significantly increase patient risks, challenging assumptions about surgical exclusion.
Area of Science:
- Nephrology
- Cardiology
- Cardiovascular Surgery
Background:
- Increased life expectancy in patients undergoing chronic dialysis leads to a higher incidence of correctable cardiac conditions.
- Historically, cardiac disease in dialysis patients carried a poor prognosis, often leading to surgical exclusion.
Purpose of the Study:
- To evaluate the feasibility and outcomes of surgical cardiac interventions in patients with chronic renal insufficiency undergoing chronic dialysis.
- To determine if cardiac surgery significantly increases risks for patients on long-term dialysis.
Main Methods:
- A series of nine patients (8 coronary artery bypass grafting, 1 aortic valve replacement) on chronic dialysis were analyzed.
- Patient data including age, duration of dialysis, and surgical outcomes were reviewed.
Main Results:
- The mean age of patients was 51 years, with a mean dialysis duration of 47 months.
- Successful management of coronary and valvular heart disease was achieved in this cohort.
- Surgical risks were not markedly increased by the presence of chronic renal insufficiency and dialysis treatment.
Conclusions:
- Patients with chronic renal insufficiency on chronic dialysis should not be routinely excluded from cardiac surgery.
- Surgical interventions for correctable cardiac disease are feasible and can be successfully managed in dialysis patients.
- This study demonstrates a shift towards improved prognosis for cardiac interventions in this patient population.
Abstract:
Prolongation of life expectancy achieved by chronic dialysis permits occurrence of correctable cardiac disease to an increasing degree. In contrast to the previously poor prognosis in dialysis patients with coronary and valvular heart disease the present series demonstrates successful management of such interventions. Nine patients are presented (8 bypass operations, one aortic valve replacement) with a mean age of 51 years and a mean duration of dialysis treatment of 47 months. Patient risks are not markedly increased by this additional disease. Patients with chronic renal insufficiency and chronic continuous dialysis should not generally be excluded from surgery due to an assumed increased risk of operation.