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J Thorac Cardiovasc Surg 1999;118:306-315
© 1999 Mosby, Inc.

SURGERY FOR ACQUIRED CARDIOVASCULAR DISEASE

CARDIAC SURGERY WITH CARDIOPULMONARY BYPASS IN PATIENTS WITH CHRONIC RENAL FAILURE

sa Durmaz, MD^a, Suat Büket, MD^a, Yüksel Atay, MD^a, Tahir Yadi, MD^a, Mustafa Özbaran, MD^a, Mehmet Boa, MD^a, lker Alat, MD^a, Asuman Güzelant, MD^b, evket Baarir, MD^a

From the Ege University Medical Faculty, Department of Cardiovascular Surgery,^a and the Konak Mother and Child Health Centre,^b zmir, Turkey.

Address for reprints: sa Durmaz, MD, Ege University Medical Faculty, Department of Cardiovascular Surgery, Bornova, zmir 35100, Turkey.

Objective: Renal failure is known to increase the morbidity and mortality in patients undergoing cardiac surgery. The results of heart surgery in patients with non–dialysis-dependent, mild renal insufficiency are not clear.
Methods: One hundred nineteen adult patients with chronic renal failure underwent cardiac surgery. Group I consisted of 93 patients who had creatinine levels between 1.6 and 2.5 mg/dL but who were not supported by dialysis. Group II consisted of 18 patients with creatinine levels higher than 2.5 mg/dL who were not supported by dialysis. Group III consisted of 8 patients with end-stage renal disease who were receiving hemodialysis.
Results: The hospital mortality rates were 11.8%, 33.0%, and 12.5%, respectively. Morbidity was 21.5%, 44.4%, and 75.0%, respectively, in groups I, II, and III. Postoperative hemodialysis was needed in 2 (2.15%) patients from group I and 6 (33%) patients from group II. On multivariable logistic regression analysis, risk factors for mortality were preoperative creatinine level more than 2.5 mg/dL, angina class III-IV, emergency operation, excessive mediastinal hemorrhage, postoperative pulmonary insufficiency, low cardiac output, and rhythm disturbances. Risk factors for morbidity were preoperative creatinine level more than 2.5 mg/dL and postoperative dialysis.
Conclusions: Chronic renal failure increases the mortality and morbidity in patients undergoing cardiac surgery. Renal insufficiency with creatinine levels higher than 2.5 mg/dL increases the risk of postoperative dialysis and prolongs the length of hospital stay. Careful preoperative management and intraoperative techniques, such as avoiding low perfusion pressure and using low-dose dopamine, may be useful for a good operative outcome.

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