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[Cardiac surgery in chronic hemodialysed patients: immediate and long-term results]
P H Deleuze1, J P Mazzucotelli, J M Maillet
1Service de chirurgie thoracique et cardiovasculaire, hôpital Henri-Mondor, Créteil.
Insights
Cardiac surgery in patients on chronic hemodialysis presents high risks, with an 18% early mortality rate, particularly for complex procedures. This highlights the need for careful patient selection and management in this vulnerable population.
Area of Science:
- Cardiology
- Nephrology
- Cardiac Surgery
Context:
- Patients undergoing chronic hemodialysis (CHD) face significant risks during cardiac surgery.
- This study examines surgical outcomes in a cohort of CHD patients over a 14-year period.
Purpose:
- To evaluate the early mortality and morbidity associated with cardiac surgical procedures in patients on chronic hemodialysis.
- To identify factors influencing outcomes in this high-risk patient group.
Summary:
- Fifty patients on CHD underwent 53 cardiac procedures (coronary bypass, valve replacement, combined surgery).
- Preoperative conditions included advanced NYHA functional class (54%), low ejection fraction (32%), and emergency referrals (24%).
- Global early mortality was 18%, with higher rates for complex procedures (50%) compared to isolated coronary bypass (10%) or aortic valve replacement (7%).
Impact:
- The findings underscore the substantial risks of cardiac surgery in the chronic hemodialysis population.
- Results suggest a need for optimized patient selection, surgical planning, and postoperative care to mitigate adverse outcomes.
Abstract:
Between 1979 and 1993, 50 patients (33 men and 17 women) receiving chronic haemodialysis, underwent 53 cardiac surgical procedures in the department. The mean age was 56 +/- 13 years. The average duration of preoperative dialysis was 82 +/- 63 months. The average duration of cardiac symptoms before surgery was 35 +/- 52 months. Twenty-seven patients (54%) were in NYHA functional classes III or IV before surgery. Sixteen patients (32%) had preoperative left ventricular ejection fractions of less than 0.40. Twelve patients (24%) were emergency referrals. Twenty-nine patients underwent isolated coronary bypass surgery, 13 patients underwent isolated aortic valvular replacement which had to be repeated in one case, 3 patients underwent mitral valve replacement, which had to be repeated in 2 cases, and 5 patients underwent combined surgery. The average aortic clamping time was 75 +/- 32 minutes, the average cardio-pulmonary bypass time was 125 +/- 50 minutes. The surgical revascularisation of the coronary patients was incomplete in 37% of cases because of the severity of the underlying coronary artery disease. The average postoperative bleeding was 800 +/- 650 ml; 29 patients (58%) were transfused with an average of 4.3 +/- 3 units of blood. The global early mortality was 9 patients (18%); 10% in coronary bypass, 7% in aortic valve replacement and 50% in patients with more complex procedures. The causes of death were cardiac (n = 4), sepsis (n = 2) and multiple organ failure (n = 3). The morbidity was 39%, mainly due to low cardiac output.(ABSTRACT TRUNCATED AT 250 WORDS)