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J Thorac Cardiovasc Surg 2008;135:915-922
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Early and late outcome of cardiac surgery in dialysis-dependent patients: Single-center experience with 245 consecutive patients

^a Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY
^b Division of Nephrology, Mount Sinai School of Medicine, New York, NY

Received for publication June 19, 2007; revisions received August 22, 2007; accepted for publication September 12, 2007.

^_* Address for reprints: Farzan Filsoufi, MD, Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, 1190 Fifth Ave, Box 1028, New York, NY 10029. (Email: Farzan.filsoufi{at}mountsinai.org).

Objective: Previous studies on outcome of cardiac surgery and its predictors in patients with preoperative kidney failure requiring dialysis have included small numbers of patients with limited follow-up. In addition, predictors of long-term outcome are not well characterized.

Methods: This is a retrospective analysis of prospectively collected data for 6694 patients, including 245 (3.7%) patients with end-stage kidney failure requiring dialysis who underwent cardiac surgery between January 1998 and September 2006. Potential predictors of hospital mortality, complications, and late survival were retrospectively analyzed by using multivariate regression models.

Results: Patients with end-stage kidney failure requiring dialysis had a 3.9-times higher hospital mortality rate compared with other cardiac surgery patients (12.7% vs 3.6%, P < .001). Patients with end-stage kidney failure requiring dialysis were younger but presented with more comorbidities and more severe cardiac disease than the control group. After adjusting for potential confounding factors, end-stage kidney failure requiring dialysis was identified as a predictor of hospital mortality (odds ratio, 3.1; P < .001). Patients with end-stage kidney failure requiring dialysis also had an increased risk of postoperative sepsis (odds ratio, 2.7; P < .001) and respiratory failure (odds ratio, 2.0; P < .001). Peripheral vascular disease was an independent predictor of hospital mortality in patients with end-stage kidney failure requiring dialysis (odds ratio, 2.5; P = .001). Long-term survival was significantly decreased in patients with end-stage kidney failure requiring dialysis compared with that seen in the control group (1-year and 5-year survival: 72.3% ± 3.3% and 39.0% ± 4.5% vs 94.2% ± 0.3% and 83.2% ± 0.6%, P < .001). Peripheral vascular disease (odds ratio, 2.69; P = .008) and previous stroke (odds ratio, 4.37; P < .001) were independent risk factors of late mortality in the subgroup of patients with end-stage kidney failure requiring dialysis.

Conclusions: Preoperative renal failure requiring dialysis is associated with a significant increase in hospital mortality, postoperative sepsis, and respiratory failure in patients undergoing cardiac surgery. In these patients long-term survival is particularly reduced in the presence of advanced atherosclerotic disease.

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