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Early and long-term results of cardiac surgery in dialysis patients
1Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt-am-Main, Germany.
Insights
Cardiac surgery for dialysis patients shows acceptable hospital mortality and improved long-term quality of life. Early intervention in symptomatic patients, especially those in New York Heart Association class II, is recommended.
Area of Science:
- Cardiology
- Nephrology
- Cardiac Surgery
Background:
- Cardiac surgery in patients undergoing dialysis is associated with significant mortality and morbidity.
- Limited data exists on the long-term outcomes of cardiac procedures in this high-risk population.
Purpose of the Study:
- To analyze the early and long-term results of various cardiac surgical procedures in patients on dialysis.
- To evaluate the impact of cardiac surgery on mortality and quality of life in this patient group.
Main Methods:
- Retrospective analysis of 40 patients undergoing cardiac surgery between 1981 and 1992.
- Procedures included coronary artery bypass grafting, valve replacements, and combined procedures.
- Patient data included New York Heart Association (NYHA) functional class, operative mortality, and long-term survival.
Main Results:
- Operative mortality was 15%; 11 late deaths occurred.
- Actuarial survival rates were 91% at 1 year and 69% at 5 years.
- Survivors demonstrated improved NYHA functional class, indicating enhanced quality of life.
Conclusions:
- Cardiac surgery in dialysis patients is associated with acceptable hospital mortality.
- Surgical treatment is advocated for symptomatic heart disease in dialysis patients.
- Early diagnosis and intervention, particularly in NYHA class II patients, may reduce perioperative mortality.
Abstract:
Cardiac surgery in patients receiving dialysis has a high mortality and morbidity. Early long-term results have been analysed following various cardiac operative procedures. Between 1981 and 1992, 40 patients, of mean age 55.7 (range 31-71) years underwent cardiac surgery. Procedures included coronary artery bypass grafting (20 patients), aortic valve replacement (six), mitral valve replacement (four), aortic valve or mitral valve plus coronary artery bypass grafting (one each), aortic plus mitral valves (two), heart and renal transplantation (one each), atrial septal defect closure (one) and pericardial decortication (three). Before surgery, patients were in the New York Heart Association (NYHA) classes II (5%), III (52.2%) and IV (42.5%). The operative mortality rate was 15%; survivors were in NYHA classes I (3%), II (88.2%) and III (8.8%). There were 11 late deaths. Follow-up at a mean of 35 (range 1-93) months showed actuarial survival rates of 91% (1 year) and 69% (5 years). After coronary artery bypass grafting, survival rates were 95% (1 year) and 72% (5 years). Survivors were in NYHA classes I (4.7%), II (85.5%) and III (9.5%). Cardiac surgery in dialysis patients is associated with an acceptable hospital mortality; quality of life in long-term survivors is increased. Hence, surgical treatment is advocated in patients with symptomatic heart disease. Early diagnosis and surgical intervention in NYHA class II patients may lead to a lower perioperative mortality.