Cardiovascular operations in patients with dialysis-dependent renal failure

Background. Cardiac operations in patients with endstage renal disease carry a significantly increased perioperative risk, and long-term functional results and survival are still purely defined. Methods. Therefore, we performed a retrospective analysis of 45 consecutive patients with dialysis-dependent renal failure who underwent either coronary artery bypass grafting (n = 30), valve replacement or combined procedures (n = 13), or pericardiotomy (n = 2). Mean age of the patients was 59 +/- 10 years. Results. There were two perioperative deaths (30-day mortality, 4.4%). Actuarial survival rates at 1, 2, 3, and 5 years were 0.90, 0.73, 0.67, and 0.67, respectively, after bypass operation and 0.77, 0.77, 0.77, and 0.39, respectively, after valvular or combined operation. Late deaths (n = 13) occurred 2 to 60 months after operation and were attributable to cardiac events in 7 patients. Of the longterm survivors after either bypass grafting (n = 20) or a valvular or combined procedure (n = 8), 15 and 7 patients had improved anginal status and New York Heart Association functional status, respectively, after 36 +/- 4 months (range, 21 to 66 months). Five patients underwent renal transplantation 32 +/- 9 months after cardiac operation. Conclusions. Cardiac operations in patients with endstage renal disease may be performed with a fairly low perioperative risk and the perspective of long-term functional improvement and acceptable long-term survival. (Ann Thorac Surg 1999;68:887-93) (C) 1999 by The Society of Thoracic Surgeons.