Document Detail


Preexisting atrial fibrillation as predictor for late-time mortality in patients with end-stage renal disease undergoing cardiac surgery--a multicenter study.
MedLine Citation:
PMID:  18365969     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although patients with end-stage renal disease (ESRD) are considered to be high-risk patients in cardiac surgery, the reported studies are rather small, resulting in unsatisfactory analyses of outcome determinants. Therefore, we aimed to identify possible risk factors, with a particular focus on the impact of pre-existing atrial fibrillation (AF) on the postoperative short-term and long-term mortality of ESRD patients undergoing cardiac surgery. METHODS: In a multicenter study 522 patients with ESRD undergoing CABG only (62.9 %), valve surgery only (17.2 %), or both (19.9 %) with comparable demographic and other cardiac risk factor characteristics were investigated retrospectively over a period of 10 years. The outcome was divided into perioperative (within 30 days) and late morbidity and mortality, and multivariate analysis was performed for both. RESULTS: The mean perioperative mortality was 11.5 % and the 5-year survival rate was 42 %. Emergency surgery, insulin-dependent diabetes mellitus, the number of vein grafts and age were identified as risk factors whereas complete revascularization, the use of an internal thoracic artery and the presence of sinus rhythm were identified as beneficial factors for long-term survival. 14.1 % of all patients had pre-existing AF. Although AF was not identified as an independent risk factor for perioperative mortality ( P = 0.59), it was identified as an independent predictor for late mortality ( P < 0.001). Median survival of patients without AF was 1816 days, while for patients with AF it was only 715 days. CONCLUSIONS: AF does represent an independent predictor for long-term but not perioperative mortality in patients with ESRD. However, effective treatment of AF is controversially discussed. Anticoagulation therapy or perioperative ablation of the arrhythmia should be considered in order to improve the survival of these patients.
Authors:
M Schönburg; T Ziegelhoeffer; F Weinbrenner; M Bechtel; C Detter; T Krabatsch; B Osswald; F C Riess; F Scholz; C Stamm; H H Sievers; C Bartels
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study    
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:  128-32     Citation Subset:  IM    
Affiliation:
Cardiac Surgery, Kerckhoff Klinik, Benekestrasse 2-8, Bad Nauheim, Germany. m.schoenburg@kerckhoff-klinik.de
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MeSH Terms
Descriptor/Qualifier:
Atrial Fibrillation / complications*
Coronary Artery Bypass*
Coronary Disease / complications,  surgery*
Female
Follow-Up Studies
Germany / epidemiology
Humans
Kidney Failure, Chronic / complications,  mortality*
Male
Middle Aged
Postoperative Period
Prognosis
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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