EARLY AND LONG-TERM RESULTS OF CARDIAC-SURGERY IN DIALYSIS PATIENTS

Objectives: The risk of cardiac surgery in dialysis patients is Increa sed compared with other patient groups. We analyzed early and long ter m results following various cardiac procedures. Methods: Between 1981 and 1992, 40 patients underwent cardiac surgery with a mean age of 55. 7 years (range 31-71 years). Cardiac procedures: Coronary artery bypas s grafting (CABG) n = 20, aortic valve replacement (AVR) n = 6, mitral valve replacement (MVR) n = 4, AVR + CABG n = 1, MVR + CABG n = 1, AV R + MVR n = 2, combined heart and renal transplantation n = 2, atrial septal defect-closure n = 1, pericardial decortication n = 3. The preo perative NYHA functional classes were: NYHA II 5%, III 52.2%, IV 42.5% . Operative mortality was 15% (6/40). Hospital survivors were in NYHA functional classes I (3%), II (88.2%) and III (8.8%). A followup study was performed at 35 months (mean, range 1-93 months) postoperatively. Results: There were 11 late deaths. The actuarial survival of all pat ients was 91% (1 year) and 69% (5 years). Following CABG it was 95% (1 year) and 72% (5 years). Survivors were in NYHA functional classes I 4.7%, II 85.8%, III 9.5%. Conclusion: Cardiac surgery in dialysis pati ents is associated with an acceptable hospital mortality. The quality of life of long term survivors is increased significantly. Thus we adv ocate surgical treatment in patients with symptomatic heart disease. E arly diagnosis and surgical intervention in the NYHA functional class II may lead to a lower perioperative mortality. Key words: dialysis pa tients, cardiac surgery, hospital mortality, long term results.