Document Detail


Cardiac surgery in patients on chronic hemodialysis: short and long-term survival.
MedLine Citation:
PMID:  18365968     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Open-heart surgery carries a high risk for hemodialysis patients. This study focuses on the short and long-term outcomes of hemodialysis patients undergoing heart surgery. DESIGN: The study was carried out as a retrospective analysis in the Department of Cardiothoracic Surgery in a large university-affiliated hospital. PATIENTS: 115 hemodialysis patients underwent cardiac surgery in our department between 1 July 1996 and 31 July 2006. 67.5 % (77 patients) underwent isolated coronary artery bypass grafting (CABG), 13.2 % (15 patients) underwent isolated aortic valve replacement (AVR) and 20.2 % (23 patients) underwent mitral valve surgery or combined valve and coronary artery bypass grafting or multiple valve surgery. METHODS: The relationship between several variables (age, sex, hypertension, diabetes, and previous myocardial infarction, type of disease, preoperative ejection fraction, and congestive heart failure) and operative (30 days) mortality and late survival was analyzed. RESULTS: The overall 30-day mortality was 18.3 % (21 patients). It was 13 % (10/77 patients) for the isolated CABG group and 13.3 % (2/15) for the isolated AVR group. Patients undergoing combined valve and coronary surgery or multiple valve surgery had a higher perioperative mortality of 39.1 % (9/23) compared to the isolated CABG and isolated AVR patients. Perioperative death was also higher in patients with moderate and severe LV dysfunction, and in patients with diabetes. The duration of dialysis periods was not related to perioperative death. Mean follow-up was 26.4 +/- 29.7 months (0.1 to 104 months). Actuarial survival at 1 year and 5 years was 76 % and 55 % for isolated CABG, 59 % and 21 % for isolated AVR, and 44 % and 33 % for all other cases, respectively (log rank P = 0.001). CONCLUSION: Patients on dialysis have a high risk of perioperative mortality and poor long-term survival rates. Mortality is higher and survival is worse after combined CABG and valve-related procedures or multiple valve surgery than after isolated CABG and AVR.
Authors:
A Kogan; B Medalion; R Kornowski; E Raanani; E Sharoni; A Stamler; G Sahar; E Snir; E Porat
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Thoracic and cardiovascular surgeon     Volume:  56     ISSN:  0171-6425     ISO Abbreviation:  Thorac Cardiovasc Surg     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-27     Completed Date:  2008-08-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7903387     Medline TA:  Thorac Cardiovasc Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  123-7     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tiqwa, Israel. alexander.kogan@sheba.health.gov.il
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Cardiac Surgical Procedures / mortality*
Cardiovascular Diseases / complications,  mortality,  surgery*
Female
Follow-Up Studies
Humans
Israel / epidemiology
Kidney Failure, Chronic / complications,  mortality,  therapy*
Male
Middle Aged
Prognosis
Renal Dialysis / mortality*
Retrospective Studies
Risk Factors
Survival Rate / trends
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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