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Ann Thorac Surg 2005;79:1297-1302
© 2005 The Society of Thoracic Surgeons

Original articles: Cardiovascular

Multiple Risk Assessment of Cardiovascular Surgery in Chronic Renal Failure Patients

Bartlomiej Witczak, MDa,*, Anders Hartmann, MD, PhDa, Jan L. Svennevig, MD, PhDb

a Department of Medicine (Section of Nephrology), Rikshospitalet University Hospital, University of Oslo, Oslo, Norway
b Department of Thoracic Surgery, Rikshospitalet University Hospital, University of Oslo, Oslo, Norway

Accepted for publication September 3, 2004.

* Address reprint requests to Dr Witczak, Department of Medicine, Section of Nephrology, Rikshospitalet University Hospital, 0027 Oslo, Norway (E-mail: bartlomiej.witczak{at}rikshospitalet.no).

BACKGROUND: Chronic renal failure is a major risk factor in cardiovascular surgery. We evaluated results of cardiovascular surgery in chronic renal failure patients (s-creatinine > 200 µmol/L or established dialysis) at our center from 1990 to 2000.

METHODS: One hundred and six chronic renal failure patients underwent cardiovascular surgery (56 coronary artery bypass operations, 25 valve replacements with or without coronary bypass, and 25 other major cardiovascular operations [8 thoracic aorta, 10 abdominal aorta, 7 other]). Matched controls were selected (n = 106) based on age, sex, year, and type of operation and occurrence of diabetes.

RESULTS: There were 88 men and 18 women and mean age was 64 ± 10 years (standard deviation). Demographics did not differ between chronic renal failure and control patients, except for hypertension (more prevalent in chronic renal failure group, p < 0.05). Intraoperative hemorrhage, perfusion and ischemia time, and reoperation did not differ between groups. Chronic renal failure patients received more transfusions of red blood cells, plasma, and platelets (p < 0.02). Ventilation support (27.6 ± 59.3 hours), intensive care unit stay (7.7 ± 8.3 days), and hospital stay (12.3 ± 10.5 days) were longer (p < 0.02). Early mortality was 16% versus 6.6% (p = 0.04) and 5-year mortality was 79% versus 39% (p < 0.05) for chronic renal failure and control patients, respectively. Independent preoperative risk factors of mortality for chronic renal patients were age greater than 70 years (relative risk = 2.32, p = 0.001), chronic obstructive pulmonary disease (relative risk = 2.59, p = 0.001), diabetes (relative risk = 1.80, p = 0.037), and dialysis (relative risk = 2.03, p = 0.005).

CONCLUSIONS: Chronic renal failure patients suffered more postoperative complications and had substantially increased short-term and long-term mortality rates. Independent preoperative mortality risk factors for chronic renal failure patients were age, chronic obstructive pulmonary disease, diabetes, and chronic dialysis.




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