Open heart surgery in dialysis-dependent patients with end stage renal failure

Year 2013, Volume: 4 Issue: 3, 335 - 338, 01.09.2013

Orkut Güçlü Süleyman Yazıcı Sinan Demirtaş Ahmet Çalışkan Celal Yavuz Binali Mavitaş Suat Canbaz Turan Ege

https://doi.org/10.5799/ahinjs.01.2013.03.0296

Abstract

Objective: Patients with chronic renal insufficiency remain a risky subgroup in open heart surgery because of various reasons. The incidence of cardiovascular disease in hemodialysis dependent renal failure is found to be higher when compared with the normal population. Chronic dialysis is still a very important independent risk factor for mortality and morbidity despite of many studies. In this study, we retrospectively evaluated the outcome of patients with chronic renal failure who had undergone to open cardiac surgery. Methods: The medical charts of 36 patients on maintenance dialysis who underwent cardiovascular surgery were retrospectively analyzed. Peroperative findings of these patients were analyzed from patients\' hospital records. Results: Twenty-seven men (75%) and nine women (25%) totally 36 patients were included to study. The mean age was 58.3±8.5 (range, 44-76) years. 12 patients underwent coronary artery bypass surgery, 10 had concomitant coronary artery bypass surgery and valve replacements, five had valve replacements, three had concomitant coronary artery bypass surgery and left ventriculectomy, four had valve replacement with other valve repair, two had aortic surgery due to ascending aortic aneurysms. The mean cross clamp time was 78.1±31.3 min and the mean perfusion time was 158.8±92.2 min. The mean intensive care unit stay was 60±41 hours, and the mean hospital stay was 12±5 days. Hospital mortality rate was %38.8. Conclusions: Cardiac and renal functions are closely associated with each other. Cardiac surgery operations can be applied to patients with end-stage renal failure under acceptable risks. Appropriate preoperative preparation with good postoperative patient follow-up is necessary to have acceptable levels of morbidity and mortality rates. J Clin Exp Invest 2013; 4 (3): 335-338

Keywords

Cardiac surgery, chronic renal failure, mortality

Diyalize bağımlı kronik böbrek yetmezliği olan hastalarda açık kalp cerrahisi

Abstract

Amaç: Kronik böbrek yetmezliği (KBY) olan hastalar
çeşitli nedenlerle açık kalp cerrahisi için önemli bir risk
grubunu oluşturmaktadırlar. Bu hastalarda kardiyak hastalıklar,
normal popülasyona göre daha yüksek oranda
görülür. Yapılan birçok çalışmaya göre kronik diyaliz bağımlılığı halen tek başına mortalite ve morbidite üzerine
etkili bir risk faktörüdür. Bu çalışmada, kalp cerrahisi uygulanan
KBY’li hastaların sonuçları retrospektif olarak
değerlendirildi.
Yöntem: Kardiyopulmoner bypass (KPB) altında kardiyak
cerrahi uygulanmış olan hemodiyalize bağımlı son
dönem böbrek yetmezlikli 36 hasta çalışmaya dahil edildi.
Bu hastaların peroperatif bulguları hasta dosyalarından
geriye dönük olarak incelendi.
Bulgular: Hastaların 27’si (%75) erkek, dokuzu (%25)
kadın, yaş ortalaması 58,3±8,5 (yaş aralığı 44-76) yıl
idi. Hastalardan 12’sine koroner bypass, 10’una koroner
bypass ile beraber kapak replasmanı, beş hastaya izole
kapak replasmanı, üç hastaya koroner bypass ile birlikte
sol ventrikülotomi, dört hastaya tek kapak replasmanı
ile birlikte bir veya iki kapak tamiri, iki hastaya asendan
aorta replasmanı uygulandı. Ameliyatlarda ortalama kros
klemp süresi 78,1±31,3 dakika, toplam perfüzyon süresi
ise 158,8±92,2 dakika idi. Hastaların yoğun bakımda kalma
süresi ortalama 60±41 saat, toplam hastanede yatış
süresi 12±5 gün bulundu. Postoperatif mortalite %38,8
(n=14) idi.
Sonuç: Kardiyak ve renal fonksiyonlar birbiriyle yakın
ilişkilidir. Son dönem böbrek yetmezliği olan hastalara
kabul edilebilir riskler altında kalp cerrahisi operasyonları
uygulanabilmektedir. Uygun preoperatif hazırlık, iyi hasta
takibi ile morbidite ve mortalite oranlarının kabul edilebilir
düzeylerde olması mümkündür.

Keywords

Kalp cerrahisi, kronik böbrek yetmezliği, mortalite

References

• Cheung A, Sarnak M, Yan G, et al. Cardiac diseases in maintenance haemodialysis patients: results of the HEMO study. Kidney International 2009;65:2380- 2389.
• Witczak B, Hartmann A, Svennevig JL. Multipl risk as- sessment of cardiovascular surgery in chronic renal failure patients. Ann Thorac Surg 2005;79:1297-1302.
• Cooper WA, O’Brien SM, Thourani VH, et al. Impact of renal dysfunction on outcomes of coronary artery bypass surgery. Results from the Society of Thoracic Surgeons national adult cardiac database. Circulation 2006;113:1063-1070.
• Batiuk TD, Kurtz SB, Oh JK, Orszulak TA. Coronary artery bypass operation in dialysis patients. Mayo Clin Proc 1991;66:45-53.
• Horst M, Mehlhorn U, Hoerstrup SP, et al. Cardiac sur- gery in patients with end-stage renal disease:10-year experience. Ann Thorac Surg 2000;69:96-101.
• Maze Y, Kanemitsu S, Onoda K, et al. The periopera- tive management for the patients to undergo open heart surgery with chronic renal failure. Kyobu Geka 2000;53:1095-l100.
• Gelsomino S, Morocutti G, Masullo G, et al. Open heart surgery in patients with dialysis dependent renal in- sufficiency. J Card Surg 2001;16:400-407.
• Rostand SG, Sanders C, Kirk KA, et al. Myocardial calcification and cardiac dysfunction in chronic renal failure. Am J Med 1988;85:651-657.
• Toole JM, Stroud MR, Kratz JM, et al. Valve surgery in renal dialysis patients. J Heart Valve Dis 2006;15:453- 458.
• Milani R, Brofman PR, Souza JA, et al. OPCAB in patients on hemodialysis. Rev Bras Cir Cardiovasc 2007;22:104-108.
• Filsoufi F, Rahmanian PB, Castillo JG, et al. Predic- tors and early and late outcomes of dialysis-depen- dent patients in contemporary cardiac surgery. J Car- diothorac Vasc Anesth 2008;22:522-529.
• Nicolini F, Fragnito C, Molardi A, et al. Heart surgery in patients on chronic dialysis: is there still room for improvement in early and long-term outcome? Heart Vessels 2011;26:46-54.
• Rahmanian PB, Adams DH, Castello JG, et al. Early and late outcome of cardiac surgery in dialysis de- pendent patients: single-center experience with 245 consecutive patients. J Thorac Cardiovasc Surg 2008;135:915-922.
• Liu JY, Birkmeyer NJO, Sanders JH, et al. Risks of Morbidity and Mortality in Dialysis Patients Under- going Coronary Artery Bypass Surgery. Circulation 2000;102:2973-2977.
• Ko W, Kreiger KH, Isom OW. Cardiopulmonary by- pass procedures in dialysis patients. Ann Thorac Surg 1993;55:677-684.
• Turgut AR, Özbudak E, Özerdem A, et al. Hemodiya- lize bağımlı kronik böbrek yetmezlikli hastalarda açık kalp cerrahisi. Turk Gogus Kalp Damar Hast Derg 2008;16:223-227.
• Yetkin U, Yılık L, Yakut N, et al. Kronik böbrek yetmez- likli hastalarda kalp kapak cerrahisi uygulamaları. Van Tıp Derg 2004;11:7-12.