DETERMINANTS OF EARLY AND LATE MORTALITY IN PATIENTS WITH END-STAGE RENAL-DISEASE UNDERGOING CARDIAC-SURGERY

To determine factors influencing early and late mortality associated w ith cardiovascular surgery in end-stage renal disease, 48 consecutive patients (mean age 56.3 years) were reviewed: 30 underwent coronary an d 18 valvular surgery. There were eight early deaths, three in the for mer and five in the latter group. Factors significantly related to ear ly mortality in univariate testing included infective valvular disease , emergency vs elective surgery (both p = 0.02) poor left ventricular function and prolonged clamping and bypass times (all p = 0.001). When these factors were included in a stepwise logistic regression analysi s, infective valvular disease (p = 0.02), poor left ventricular functi on (p = 0.01) and long cross-clamping (p = 0.01) were independently as sociated with early mortality. There were six late deaths. Survival fo r the whole cohort at 1, 5 and 7 years was 95%, 60.4% and 42.6%, respe ctively. Related to late mortality at univariate testing were age (p = 0.03), smoking (p = 0.04), diabetes (p = 0.03) and poor left ventricu lar function (p = 0.02), and stepwise logistic regression analysis sho wed independent association with age, diabetes and impaired left ventr icular function. Mortality associated with cardiac surgery in patients with end-stage nephropathy can be reduced by better patient selection , early operation in patients with infective endocarditis, and minimiz ed cross-clamping and bypass times.