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Early and long term results of cardiac surgery in dialysis patients
1Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt/Main, Germany.
Insights
Cardiac surgery in dialysis patients shows acceptable hospital mortality and improved long-term quality of life. Early intervention for symptomatic heart disease in NYHA class II patients is recommended.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Transplantation
Background:
- Dialysis patients face increased risks with cardiac surgery.
- This study evaluates outcomes for various cardiac procedures in this population.
Purpose of the Study:
- To analyze early and long-term results of cardiac surgery in dialysis patients.
- To assess the impact of surgical intervention on quality of life.
Main Methods:
- Retrospective analysis of 40 dialysis patients (1981-1992) undergoing diverse cardiac procedures.
- Procedures included coronary artery bypass grafting, valve replacements, and combined transplantations.
- Preoperative NYHA classes were II (5%), III (52.2%), and IV (42.5%).
Main Results:
- Operative mortality was 15%.
- One-year survival was 91% (CABG 95%), and 5-year survival was 69% (CABG 72%).
- Hospital survivors showed significant improvement in NYHA functional class.
Conclusions:
- Cardiac surgery in dialysis patients has acceptable hospital mortality.
- Long-term survivors experience a significantly improved quality of life.
- Surgical treatment is advocated for symptomatic heart disease; early intervention in NYHA class II may reduce perioperative mortality.
Objectives:
The risk of cardiac surgery in dialysis patients is increased compared with other patient groups. We analyzed early and long term results following various cardiac procedures.
Methods:
Between 1981 and 1992, 40 patients underwent cardiac surgery with a mean age of 55.7-years (range 31-71 years). Cardiac procedures: Coronary artery bypass grafting (CABG) n = 20, aortic valve replacement (AVR) n = 6, mitral valve replacement (MVR) n = 4, AVR+CABG n = 1, MVR+CABG n = 1, AVR+MVR n = 2, combined heart and renal transplantation n = 2, atrial septal defect-closure n = 1, pericardial decortication n = 3. The preoperative NYHA functional classes were: NYHA II 5%, III 52.2%, IV 42.5%. Operative mortality was 15% (6/40). Hospital survivors were in NYHA functional classes I (3%), II (88.2%) and III (8.8%). A follow-up study was performed at 35 months (mean, range 1-93 months) postoperatively.
Results:
There were 11 late deaths. The actuarial survival of all patients was 91% (1 year) and 69% (5 years). Following CABG it was 95% (1 year) and 72% (5 years). Survivors were in NYHA functional classes I 4.7%, II 85.8%, III 9.5%.
Conclusion:
Cardiac surgery in dialysis patients is associated with an acceptable hospital mortality. The quality of life of long term survivors is increased significantly. Thus we advocate surgical treatment in patients with symptomatic heart disease. Early diagnosis and surgical intervention in the NYHA functional class II may lead to a lower perioperative mortality.