Cardiac surgery with cardiopulmonary bypass in patients with chronic renalfailure

Objective: Renal failure is known to increase the morbidity and mortality i n patients undergoing cardiac surgery. The results of heart surgery in pati ents with non-dialysis-dependent, mild renal insufficiency are not clear, M ethods: One hundred nineteen adult patients with chronic renal failure unde rwent 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, Gr oup II consisted of 18 patients with creatinine levels higher than 2.5 mg/d L who were not supported by dialysis, Group III consisted of 8 patients wit h end-stage renal disease who were receiving hemodialysis. Results: The hos pital 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. Posto perative 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 he morrhage, postoperative pulmonary insufficiency, low cardiac output, and rh ythm 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 techn iques, such as avoiding low perfusion pressure and using low-dose dopamine, may be useful for a good operative outcome.