Cardiac surgery with cardiopulmonary bypass in patients with chronic renal failure


Durmaz I., Buket S., Atay Y. , Yagdi T. , Ozbaran M. , Boga M., ...More

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, vol.118, no.2, pp.306-315, 1999 (Journal Indexed in SCI) identifier identifier

  • Publication Type: Article / Article
  • Volume: 118 Issue: 2
  • Publication Date: 1999
  • Doi Number: 10.1016/s0022-5223(99)70221-7
  • Title of Journal : JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
  • Page Numbers: pp.306-315

Abstract

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.