Ранние и отдаленные результаты у пациентов с хроническим диализом после кардиохирургического лечения

Назад к программе

Leontyev S. , Mohr F.

Heart Center Leipzig;

Objective: Cardiac surgery in patients with dialysis-dependent chronic renal failure (CRF) is still associated with a high morbidity and mortality. The aim of this study was to determine the preoperative predictors of in-hospital and medium-term mortality in patients with dialysis-dependent CRF undergoing cardiac surgery and create an easy-to-use score to predict in-hospital mortality.

Methods: Between January 1996 and June 2014, 483 consecutive patients with dialysis-dependent CRF underwent various cardiac surgical procedures at our institute. Mean age was 65±11 years and 32.8% were female. Isolated coronary artery bypass graft, or isolated aortic valve and isolated mitral valve surgeries were performed in 39.8%, 17% and 6%, of patients, respectively. In all other patients (37.2%) combined surgical procedure were necessary. Endocarditis was an indication for surgery in 11% of patients. Overall, 15% of patients had undergone previous operations and 49.3% underwent urgent or emergent surgery. A multivariable logistic regression model was created to identify the independent predictors of in-hospital mortality. The results were used to create a score that could predict the operative risk.

Results: The in-hospital mortality was 15.3 %. Postoperative respiratory failure, gastrointestinal complications, low cardiac output, stroke and sepsis occurred in 22.7%, 12.6%, 11.9%, 5.6% and 5.2% of patients, respectively. The independent predictors of in-hospital mortality were combined mitral and aortic valve pathology (OR 3.7, 95% CI 1.5-9, p=0.003), chronic obstructive pulmonary disease (OR 2.6, 95% CI 1.1-5.9, p=0.03), peripheral vascular diesase (OR 1.9, 95% CI 1.04-3.5, p=0.03), left ventricular ejection fraction <30% (OR 2.9, 95% CI 1.3-6.4, p=0.008) and active endocarditis (OR 2.2, 95% CI 1.04-4.6, p=0.04). The estimated 1-, 3- and 5-year survival was 58±2%, 41±2%, and 25±2%, respectively with a mean survival time of 3.4±0.2 years. Previous cerebrovascular accident, active endocarditis, prior cardiac surgery and combined aortic/mitral valve pathology were independent predictors of medium-term mortality.

Conclusions: Patients with dialysis-dependent CRF undergoing cardiac surgery have a high perioperative and medium-term mortality, particularly in the presence of combined aortic and mitral valve pathology, active endocarditis and poor left ventricular function.

Комментарии посетителей

нет комментариев
Комментарии могут отправлять участники данного мероприятия или члены Ассоциации.