Gli interventi cardiochirurgici nei pazienti in dialisi cronica: risultati a breve e lungo termine

Background. Chronic dialysis is a relevant risk factor for mortality and morbidity after cardiac surgery and cardiopulmonary bypass. The aim of this study was to evaluate the short- and long-term follow-up of patients in dialysis undergoing cardiac surgery. Methods. We retrospectively reviewed 24 consecutive chronic hemodialysis adult patients (14 males, 10 females, mean age 63 ± 12 years) who, over a 10-year period, underwent operative cardiac procedures in our Institution. Prior to surgery the mean duration of dialysis was 55 ± 18 months (minimum 3 months). Surgery included isolated coronary artery bypass grafting in 18 patients, aortic valve replacement in 3, mitral valve replacement in 2, and double valve replacement (mitral and aortic) in 1. Sixteen operations were elective whereas 8 (33%) were performed in an emergency setting. Results. Seven operative deaths occurred with an overall in-hospital mortality of 29%. Among the 16 patients in whom surgery was elective, only 2 died. Five of the 8 patients submitted to emergency procedures died. Hence, the operative mortality in this subgroup of patients was 62% (p < 0.005). A low cardiac output and multiorgan failure due to pulmonary infection were the most important causes of death. However 75% of patients experienced some major postoperative complications. All survivors were followed up for 6 to 108 months (mean 33.7 ± 29.5 months). The overall functional status was significantly improved. Survival at 1, 2 and 5 years was 68, 63 and 45% respectively in coronary patients and 65, 58 and 42% in the overall study population. Conclusions. In dialysis-dependent patients major cardiac procedures can be carried out with an acceptable risk only in elective conditions even if the mortality is 4-5-fold higher than in the normal population and the life expectancy is similar to that of patients in chronic dialysis but without cardiac disease. (Ital Heart J Suppl 2002; 3 (7): 746-752)