• J. Thorac. Cardiovasc. Surg. · Jul 2012

    Short- and long-term outcomes in patients undergoing valve surgery with end-stage renal failure receiving chronic hemodialysis.

    • Vinod H Thourani, Eric L Sarin, Patrick D Kilgo, Omar M Lattouf, John D Puskas, Edward P Chen, and Robert A Guyton.
    • Clinical Research Unit, Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, GA 30308, USA. vthoura@emory.edu
    • J. Thorac. Cardiovasc. Surg. 2012 Jul 1; 144 (1): 117-23.

    ObjectivesThe objective of this study was to evaluate the effect of chronic preoperative hemodialysis for end-stage renal failure in patients undergoing valve surgery.MethodsA retrospective review of patients undergoing primary valve with or without coronary artery bypass surgery from 1996 to 2008 at a US academic center was performed. The patients were divided into two groups: group 1 underwent valve surgery without preoperative dialysis (n = 5084) and group 2 underwent valve surgery with preoperative dialysis (n = 224). The outcomes were evaluated using multivariate regression analysis, and long-term survival was assessed with Kaplan-Meier plots.ResultsThe patients in group 2 were younger (P < .001), were more likely women (P = .04), and presented with New York Heart Association class III-IV (P < .001). The ejection fraction was similar between the two groups (P = .36). The adjusted perioperative morbidity was similar between the two groups for stroke (P = .79) and myocardial infarction (P = .68). Resource use (postoperative length of stay) was greater in group 2 (P < .001), as was in-hospital mortality (group 1, 263/5084 [5.2%] vs group 2, 41/224 [18.3%]; P < .001). The 1-, 5-, and 10-year survival was less in group 2 (P < .001); the median survival was 12 or more years in group 1 and 1.8 years in group 2. Preoperative end-state renal disease, among others, show a trend as an independent predictor for short-term mortality and was a significant predictor for long-term mortality.ConclusionsIn this large cohort of patients, preoperative dialysis conferred a high risk of perioperative morbidity and mortality and poor long-term survival after valve surgery. Risk stratification and future research efforts should focus on more precise identification of the benefits of valve surgery in this high-risk patient population.Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

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