Cardiac Surgery in Patients on Chronic Hemodialysis: Short and Long-Term Survival

Abstract

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.

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

“…104 Although surgical replacement with either a bioprosthetic or mechanical valve has been shown to confer a reduction in mortality in patients who survive the perioperative period, perioperative mortality with cardiac surgery in patients with ESRD remains extremely high and limits the surgical options in this patient population. [105][106][107][108] According to the Society of Thoracic Surgeons risk model, aortic valve replacement (AVR) in patients with ESRD is associated with significantly high perioperative mortality, with an odds ratio of 2.8 for operative mortality defined as death within the same hospitalization as surgery and within 30 days after discharge. 109 Similarly, mitral valve repair is associated with an odds ratio of 4.59 for operative mortality.…”

New-Onset Atrial Fibrillation Predicts Long-Term Mortality After Coronary Artery Bypass Graft

“…Those patients with POAF appeared to be older and sicker than those without POAF, a finding consistently seen in other studies (17)(18)(19)(20) and in ours. Although the investigators adjusted for many comorbid conditions when testing the effect of POAF on mortality, they did not account for the effect of race (21,22), ejection fraction (23), the presence of concomitant valve disease (15), dialysis (24), left main coronary artery disease (25), or creatinine level (26,27). The Texas Heart Institute study did not find an association between warfarin use on discharge and reduced mortality in POAF.…”

Comparing Cardiac Surgery in Peritoneal Dialysis and Hemodialysis Patients: Perioperative Outcomes and Two-Year Survival

“…32, NO. 2 PDI on the study (1,(4)(5)(6)(7). Length of hospital stay does not appear to be excessively prolonged in ESRD patients (8).…”