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.
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