Implications of end-stage renal disease on cardiac surgery

Abstract

End-stage renal failure requiring dialysis is considered a significant risk factor in cardiac surgery. To assess the risk we performed a retrospective analysis of 17 patients with end-stage renal failure who underwent open heart surgery during 1994 and 1995. Pre-, peri-, and postoperatively we evaluated the following factors: renal failure etiology, risk factors, concurrent diseases, previous heart diseases, complications, mortality, and long-term outcome. All patients were dialyzed on the day before surgery. Intraoperative hemofiltration was performed in each patient. The first postoperative hemodialysis was performed on the second postoperative day or earlier for hyperkalemia or pulmonary edema. Postoperative complications occurred in seven patients: three patients expired postoperatively of noncardiac and nonreal causes and four died during follow-up. With an average follow-up of 16.5 months (range 7–30 months) NYHA class had improved by an average of 1.7 in the 10 patients who were alive and their quality of life was acceptable. Because of these acceptable short- and long-term results and relatively low operative risk, we support an approach of prompt diagnostic work-up and surgical intervention when necessary.