CARDIAC-SURGERY IN PATIENTS UNDER CHRONIC-HEMODIALYSIS

A total of 15 chronic renal failure patients on hemodialysis therapy u nderwent some kind of cardiovascular surgery between August 1984 and M arch 1993. Ten had a valve abnormality, and the remaining five had cor onary artery disease. All of them were hemodialyzed the day before sur gery and 24-48 h after the operation. Eleven recovered well after surg ery, four died of septic shock: two of these were in septic shock prio r to surgery; one was in acute congestive heart failure, and one was o perated during an acute myocardial infarction. All operative deaths oc curred in the patients who underwent non-elective surgery or were preo peratively in New Heart Association (NYHA) class IV. The factors havin g an impact on morbidity and mortality seem to be more related to the previous clinical situation and to the urgency of the operation than t o the status of chronic renal failure. An early and adequate assessmen t of the candidates, when possible avoiding emergency surgery and acut e left ventricular dysfunction, as well as careful management during c ardiopulmonary bypass procedures (CPB) and the immediate post-surgical period will certainly improve the result of cardiac surgery in these patients, making it similar to those who are not in chronic renal fail ure.