Cardiac surgery in patients with end-stage renal disease: 10-year experience

Horst, Michael; Mehlhorn, Uwe; Hoerstrup, Simon P.; Suedkamp, Michael; Vivie, E. R. de

doi:10.1016/s0003-4975(99)01133-9

Cited by 136 publications

(92 citation statements)

References 16 publications

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“…In a series of 19 patients described by Lucke et al, 6 the 30-day mortality was 16%, and the estimated survival was 60Ϯ12% at 1 year and 42Ϯ14% at 5 years. Horst et al 4 reported perioperative mortality in 7 of 32 dialysis patients (22%) undergoing valve replacement at the University of Cologne in Germany.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Survival of Dialysis Patients in the United States With Prosthetic Heart Valves

2002

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Background — Minimal data exist on the long-term survival of dialysis patients after cardiac valve surgery. Current practice guidelines of the American College of Cardiology/American Heart Association Task Force on the management of patients with valvular heart disease proscribe the use of bioprosthetic (tissue) valves in hemodialysis patients. Methods and Results — Dialysis patients hospitalized for heart valve replacement surgery from 1978 to 1998 were retrospectively identified from the US Renal Data System database. Long-term survival was estimated by the life-table method. The impact of demographic differences and comorbidity on outcome were examined in a Cox proportional hazards model. The in-hospital mortality of 5858 dialysis patients undergoing valve surgery was 20.7%. Aortic valve replacement was performed in 3415 patients (58%), mitral valve replacement in 1848 patients (32%), and combined aortic and mitral valve replacement in 562 patients (10%). Tissue valves were used in 881 patients. There was no significant difference in survival related to type of prosthetic valve. The 2-year survival rate was 39.7±3.5% with tissue valves versus 39.7±1.4% for nontissue valves. Compared with nontissue prosthetic valves, the use of tissue valves was not predictive of death (RR 0.98; 95% CI 0.90 to 1.07). Conclusions — There is no significant difference in survival of dialysis patients after cardiac valve replacement with tissue versus nontissue prosthetic valves. Current practice guidelines proscribing the use of bioprosthetic heart valves in hemodialysis patients should be rescinded.

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Section: Discussionmentioning

confidence: 99%

Long-Term Survival of Dialysis Patients in the United States With Prosthetic Heart Valves

2002

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“…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).…”

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confidence: 88%

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

et al. 2012

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♦ Background: We sought to compare perioperative outcomes and 2-year survival in a cohort of peritoneal dialysis (PD) patients compared with matched hemodialysis (HD) patients who underwent cardiothoracic surgery at our institution. ♦ Methods: We obtained a list of all dialysis-dependent patients who underwent cardiac surgery (coronary artery bypass grafting, valve replacement, or both) at our center between 1994 and 2008. All patients undergoing PD at the time of surgery were included in our analysis. Two HD patients matched for age, diabetes status, and Charleston comorbidity score were obtained for each PD patient. ♦ Results: The analysis included 36 PD patients and 72 HD patients. Mean age, sex, diabetes status, cardiac unit stay, hospital stay, and operative mortality did not differ by dialysis modality. The incidence of 1 or more postoperative complications (infection, prolonged intubation, death) was higher for HD patients (50% vs. 28% for PD patients, p = 0.046). After surgery, 2 PD patients required conversion to HD. The 2-year survival was 69% for PD patients and 66% for HD patients (p = 0.73). ♦ Conclusions: Our findings suggest that, compared with HD patients, PD patients who require cardiac surgery do not experience more early complications or a lesser 2-year survival and that 2-year survival for dialysis patients after cardiac surgery is acceptable.

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“…For the past few decades, various studies have reported the clinical outcome of cardiac surgery in CRF patients, but almost all have been from single centers or consist of less than 200 patients. 1 Moreover, we found few previous large-scale studies that focused on isolated CABG and included multivariate analysis of perioperative risk factors of operative mortality. 8 Therefore, in the present study we examined 19,687 isolated CABG patients, including 1,300 HD-dependent patients,…”

Section: Editorial P 1085mentioning

confidence: 99%

Coronary Artery Bypass Grafting in Hemodialysis-Dependent Patients

Yamauchi

Matsubara

Sakaguchi

et al. 2012

Circ J

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Background: Perioperative risk during coronary artery bypass grafting (CABG) is reportedly high in patients with chronic renal disease. We aimed to determine postoperative mortality and morbidity and identify the perioperative risk factors of mortality during CABG in hemodialysis (HD)-dependent patients. Methods and Results:From the Japan Adult Cardiovascular Surgery Database, we compared 1,300 HD-dependent chronic renal failure patients with 18,387 non-HD patients who all underwent isolated CABG between January 2005 and December 2008. The operative mortality and mortality, including major morbidity, was 4.8% vs. 1.4% and 23.1% vs. 13.7% in the HD and non-HD groups, respectively. Preoperative predictors of operative mortality included age, chronic obstructive pulmonary disease, peripheral arterial disease, congestive heart failure, arrhythmia, preoperative inotropic agent requirement, New York Heart Association class IV, urgent or emergency operation, poor left ventricular function, aortic valve regurgitation (>2), and mitral valve regurgitation (>3). Postoperative predictors of operative mortality included stroke, infection, prolonged ventilation, pneumonia, heart block, and gastrointestinal complications. Conclusions:Compared with non-HD patients, CABG in HD patients was associated with high mortality and morbidity rates. An appropriate surgical strategy and careful perioperative assessment and management for prevention of respiratory and gastrointestinal complications might contribute to improved clinical outcomes after CABG in these patients. (Circ J 2012; 76: 1115 - 1120

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Cardiac surgery in patients with end-stage renal disease: 10-year experience

Cited by 136 publications

References 16 publications

Long-Term Survival of Dialysis Patients in the United States With Prosthetic Heart Valves

Long-Term Survival of Dialysis Patients in the United States With Prosthetic Heart Valves

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

Coronary Artery Bypass Grafting in Hemodialysis-Dependent Patients

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