Cardiac surgery with cardiopulmonary bypass in patients with chronic renal failure

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 118; no. 2; pp. 306 - 315
• Main Authors: Durmaz, İsa, Büket, Suat, Atay, Yüksel, Yağdı, Tahir, Özbaran, Mustafa, Boğa, Mehmet, Alat, İlker, Güzelant, Asuman, Başarır, Şevket
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01-08-1999; AATS/WTSA; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiac Surgical Procedures - methods; Cardiac Surgical Procedures - mortality; Cardiopulmonary Bypass - mortality; Creatinine - blood; Female; Follow-Up Studies; Heart Diseases - complications; Heart Diseases - mortality; Heart Diseases - surgery; Hospital Mortality; Humans; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - mortality; Length of Stay; Male; Medical sciences; Middle Aged; Postoperative Complications - mortality; Retrospective Studies; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate; Treatment Outcome; Kidney disease; Heart; Human; Urinary system disease; Prognosis; Survival; Cardiopulmonary bypass; Chronic; Treatment; Follow up study; Surgery; Renal failure; Anesthesia; Bibliographic review
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/S0022-5223(99)70221-7

Objective: Renal failure is known to increase the morbidity and mortality in patients undergoing cardiac surgery. The results of heart surgery in patients with non–dialysis-dependent, mild renal insufficiency are not clear.
Methods: One hundred nineteen adult patients with chronic renal failure underwent cardiac surgery. Group I consisted of 93 patients who had creatinine levels between 1.6 and 2.5 mg/dL but who were not supported by dialysis. Group II consisted of 18 patients with creatinine levels higher than 2.5 mg/dL who were not supported by dialysis. Group III consisted of 8 patients with end-stage renal disease who were receiving hemodialysis.
Results: The hospital mortality rates were 11.8%, 33.0%, and 12.5%, respectively. Morbidity was 21.5%, 44.4%, and 75.0%, respectively, in groups I, II, and III. Postoperative hemodialysis was needed in 2 (2.15%) patients from group I and 6 (33%) patients from group II. On multivariable logistic regression analysis, risk factors for mortality were preoperative creatinine level more than 2.5 mg/dL, angina class III-IV, emergency operation, excessive mediastinal hemorrhage, postoperative pulmonary insufficiency, low cardiac output, and rhythm disturbances. Risk factors for morbidity were preoperative creatinine level more than 2.5 mg/dL and postoperative dialysis.
Conclusions: Chronic renal failure increases the mortality and morbidity in patients undergoing cardiac surgery. Renal insufficiency with creatinine levels higher than 2.5 mg/dL increases the risk of postoperative dialysis and prolongs the length of hospital stay. Careful preoperative management and intraoperative techniques, such as avoiding low perfusion pressure and using low-dose dopamine, may be useful for a good operative outcome. (J Thorac Cardiovasc Surg 1999;118:306-15)