The Annals of Thoracic Surgery, Vol 57, 691-696, Copyright © 1994 by The Society of Thoracic Surgeons
Cardiac operations in patients with end-stage renal disease
TK Kaul, BL Fields, MA Reddy and DR Kahn
Department of Cardiac Surgery, Baptist Medical Center-Princeton, Birmingham, Alabama 35211.
Factors influencing the survival of 35 consecutive patients in end- stage
renal disease who required 40 open heart surgical procedures over the past
8 years were studied. The mean age in these patients was 57.7 +/- 3 years
(range, 32 to 77 years); 74.3% of the patients were male; and the average
duration of hemodialysis was 3.6 +/- 0.6 years. Twenty- nine myocardial
procedures (20 of 29 for unstable angina), six valve replacements, and five
combined procedures were performed. The actuarial survivals at 1 and 3
months, and at 1, 5, and 8 years were 90%, 85%, 76%, 55%, and 43%,
respectively. Based on the results of univariate analysis, the most
significant predictor of both early and late mortality was New York Heart
Association (NYHA) class IV congestive heart failure. The 5-year survival
in the patients 60 years and older was less favorable than that in patients
younger than 60 years (45% versus 63%) (p < 0.05). The 5-year survival
in the patients in NYHA class IV was only 27%, as compared to 63% in the
patients in class II or III (p < 0.001). All survivors have remained
free of angina and 19 of the 21 survivors showed an improvement in their
NYHA class. Four patients under 40 years of age have subsequently been able
to undergo renal transplantation. Overall, these results justify proceeding
with an open heart surgical procedure in dialysis patients, when needed,
but before the onset of congestive heart failure.
