Considerations in the management of open-heart surgery in uremic patients

Life-threatening complications involving the central circulation commonly occur in uremic patients. The growing number of individuals maintained on long-term hemodialysis along with repeated demonstrations of their ability to tolerate major operative procedures are responsible for increasing surgical experience in this group. Despite a high incidence of subacute bacterial endocarditis (SBE) and accelerated coronary atherosclerosis, exposure of such patients to open-heart operations has been limited. Our management of two patients who recently underwent valvular replacement is outlined and a review of the literature revealed that, during the past decade, 20 uremic patients have undergone a variety of cardiac procedures. The catastrophic results of medical therapy in such individuals with SBE are emphasized and early surgical intervention is recommended.