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The Annals of Thoracic Surgery, Vol 55, 677-684, Copyright © 1993 by The Society of Thoracic Surgeons
W Ko, KH Kreiger and OW Isom
To determine the operative outcome of chronic renal failure patients, we
retrospectively reviewed twenty-five consecutive adult patients with
chronic renal failure dependent on maintenance hemodialysis (21) or
peritoneal dialysis (3), who underwent cardiopulmonary bypass procedures
over a five-year period in our institution. The operations included
isolated coronary artery bypass grafting in 16 patients; aortic valve
replacement in 3; aortic valve replacement plus mitral valve replacement in
1; aortic valve replacement, mitral valve replacement, and coronary artery
bypass grafting in 2; aortic valve replacement and coronary artery bypass
grafting in 1, mitral valve replacement and coronary artery bypass grafting
in 1, and repair of a thoracoabdominal aortic aneurysm in 1 patient.
Fourteen operations were elective, and 11 were urgent or emergent. The
number of patients with good (> 0.50), fair (0.30 to 0.50), and poor
(< 0.30) left ventricular ejection fractions were 13, 9, and 3,
respectively. There were 0, 7, 7, and 11 patients in New York Heart
Association functional classification I, II, III, and IV, respectively. All
patients were dialyzed within 24 hours before operation. All but 3 patients
were managed by immediate postoperative peritoneal dialysis via a Technoff
catheter placed intraoperatively (18 patients) or via a preexisting
Technoff catheter (4 patients). This was then switched to hemodialysis when
clinical conditions stabilized. Univariate analysis of 22 preoperative and
intraoperative variables, followed by a multivariate analysis with a
stepwise logistic regression model, was performed using the 30-day or
in-hospital operative mortality as the dependent variable.(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Cardiopulmonary bypass procedures in dialysis patients
Department of Surgery, New York Hospital-Cornell University Medical College, New York 10021.
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