Abstract
Objectives This study evaluates midterm survival rates and risk factors for mortality of chronic
dialysis-dependent patients undergoing cardiac surgery.
Methods Fifty-three dialysis-dependent patients (34 males, aged 67 ± 12 years) with end-stage
renal disease operated within March 2007 and May 2012 were analyzed retrospectively.
Survival rates were calculated using Kaplan–Meier methods. Predictors of midterm survival
were identified with multivariate Cox-regression analysis.
Results Twenty-three patients received isolated coronary artery bypass graft surgery, 17
received isolated valve replacement, and 13 received combined procedures. Thirty-day
mortality was 24.5% (n = 13). Follow-up was complete for 94.3% (n = 50). Survival rates at 1, 3, and 5 years were: 82, 50, and 17%, respectively. Neither
age, gender, poor ejection fraction, emergency, ECC/X-clamp (cross-clamp) time, nor
use of left internal thoracic artery or right internal thoracic artery had any influence
on midterm survival. Causes of death within midterm follow-up period were related
to cardiac events in 16% and neurological events in 16%. In the majority (47%), cause
of death was associated with peripheral arterial disease (PAD).
The only comorbidity, which could be identified as a significant risk factor, was
PAD (p = 0.035). Five patients underwent successful renal transplantation within the follow-up
period.
Conclusion Although 30-day mortality in this high-risk patient population was increased, midterm
survival rates were comparable to the results described in the literature. Cause of
death within midterm follow-up period was mostly noncardiac related. Given the limited
number of patients, predictors for enhanced 30-day mortality, such as preoperative
myocardial infarction, prolonged extracorporeal circulation, operation time, and diabetes
mellitus, did not have an influence on midterm survival.
Keywords
cardiac - kidney - peripheral vascular disease
