Perioperative Management of Chronic Dialysis Patients Undergoing Cardiac Surgery

Abstract

Introduction: Chronic kidney disease is associated with signifi cant cardiovascular morbidity and mortality. Cardiac surgery in patients undergoing dialysis is still challenging due to increased perioperative complication rates and mortality. The aim of this study is to document the outcomes of cardiac surgery in end stage renal disease patients and analyze the impact of perioperative management strategies. Patients and Methods: Nineteen patients with end-stage renal disease undergoing hemodialysis (n= 17) or peritoneal dialysis (n= 2) operated between January 2011 and November 2012 were studied retrospectively. Isolated coronary bypass, coronary bypass concomitant with mitral valve procedures or mitral and/or tricuspid valve surgery were performed. Postoperative variables, mortality and survival rates were studied. Results: The mean age of the patients was 56.32 ± 12.97 years. Male to female ratio was 10/9. The mean duration of preoperative hemodialysis was 4.07 ± 1.89 and peritoneal dialysis was 1.5 ± 0.7 years. Mean cross-clamp time was 57.63 ± 21.56 minutes and cardiopulmonary bypass time was 87.89 ± 24.66 minutes. Mean amount of ultrafi ltration performed intraoperatively was 1610.53 ± 607.26 mL. Three (15.8%) in-hospital mortalities were noted. The median follow-up was 16 months and survival rate was 84.2%. Conclusion: A well planned surgical strategy and perioperative medical management including the timing of pre and postoperative hemodialysis, use or avoidance of cardiopulmonary bypass and the use of intraoperative ultrafi ltration should be documented to decrease perioperative morbidity and mortality.

Keywords

• Renal dialysis; kidney failure, chronic; cardiac surgical procedures

Kalp Cerrahisi Uygulanan Kronik Diyaliz Hastalarında Perioperatif İdare

Abstract

Giriş: Kronik böbrek hastalığı belirgin kardiyovasküler morbidite ve mortaliteye sahiptir. Yüksek perioperatif komplikasyon oranları ve mortalite sebebiyle diyaliz yapılan hastalarda kalp cerrahisi oldukça zordur. Bu çalışmanın amacı kalp cerrahisi yapılan son dönem böbrek hastalarında tedavi sonuçlarının ortaya konması ve perioperatif hasta idare stratejilerinin etkisinin araştırılmasıdır. Hastalar ve Yöntem: Ocak 2011-Kasım 2012 tarihleri arasında opere edilen hemodiyaliz (n= 17) ya da periton diyalizi (n= 2) uygulanan son dönem böbrek hastaları retrospektif olarak incelendi. İzole koroner baypas, koroner baypasla beraber mitral kapak prosedürleri ya da mitral ve/veya triküspid kapak cerrahisi uygulandı. Postoperatif değişkenler, mortalite ve sağkalım oranları çalışıldı. Bulgular: Hastaların ortalama yaşı 56.32 ± 12.97 yıl idi. Erkek/kadın hasta oranı 10/9 idi. Ortalama hemodiyaliz süresi 4.07 ± 1.89 yıl, ortalama periton diyalizi süresi ise 1.5 ± 0.7 yıl idi. Ortalama kros-klemp süresi 57.63 ± 21.56 dakika, ortalama kardiyopulmoner baypas süresi ise 87.89 ± 24.66 dakika idi. İntraoperatif dönemde ortalama 1610.53 ± 607.26 mL ultrafi ltrasyon yapıldı. Üç (%15.8) hasta hastane yatışı sırasında kaybedildi. Ortanca takip süresi 16 aydı ve sağkalım %84.2 idi. Sonuç: Perioperatif morbidite ve mortalitenin düşürülmesi amaçlı preoperatif ve postoperatif hemodiyaliz planlaması, kardiyopulmoner baypasın kullanılması ya da kullanımından kaçınılması ve intraoperatif ultrafi ltrasyon uygulaması gibi perioperatif hasta idaresiyle beraber iyi planlanmış bir cerrahi strateji belirlenmelidir.

Keywords

• Böbrek diyalizi; böbrek yetmezliği, kronik; kardiyak cerrahi girişimler.

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