Ranchordas Sara, Madeira Márcio, Pereira Tiago, Branco Patrícia, Gaspar Augusta, Marques Marta, Calquinha José, Abecacis Miguel, P Neves José
Cardiac surgery, Hospital Santa Cruz, Carnaxide, Portugal.
Nephrology, Hospital Curry Cabral, Lisboa, Portugal.
Rev Port Cir Cardiotorac Vasc. 2019 Jul-Sep;26(3):199-204.
Patients under dialysis have a high cardiovascular risk and they are at increased risk when submitted to cardiac surgery.
to evaluate morbidity, early and late mortality, and predictive factors of mortality in patients under dialysis who underwent cardiac surgery.
A retrospective observational study was performed including all dialysis dependent patients who underwent cardiac surgery (coronary, valvular or combined procedures) in our institution between 2007 and 2014. A population of 95 consecutive patients was obtained (no exclusions). Perioperative variables and predictors of mortality were analysed and the endpoints were early and late mortality. Propensity score matching, with a control group of patients with creatinine clearance >90mL/min, was performed by logistic regression, with a 1:1 matching. Kaplan Meier curves were performed for late mortality.
Early mortality was 9.4% (EuroSCORE II 4.1%). In univariate analysis, mean time of cardiopulmonary bypass (CPB) (p=0.016) and EuroSCORE II (p=0.02) were related with early mortality. In a multivariate analysis model, combined procedures (OR 138.09; CI95% 1.82-10498.4; p=0.03) and CCS (Canadian Cardiovascular Society) 3-4 (OR 70.951; CI 95% 1.32-3810.11; p=0.037) were predictors of mortality. In multivariable analysis, CPB time >152 min was a predictor of early mortality (p=0.001). After propensity score matching, 30 day, one year and late mortality were higher in the dialysis group.
Early and late mortality were significantly higher in dialysis dependent patients. Predictive factors of mortality were CPB time and EuroSCORE II in univariable analysis, and CCS 3-4 and combined procedures in multivariable analysis.
接受透析治疗的患者心血管风险较高，接受心脏手术时风险更高。
评估接受心脏手术的透析患者的发病率、早期和晚期死亡率以及死亡预测因素。
进行一项回顾性观察研究，纳入2007年至2014年期间在我院接受心脏手术（冠状动脉、瓣膜或联合手术）的所有依赖透析的患者。共纳入95例连续患者（无排除）。分析围手术期变量和死亡预测因素，终点为早期和晚期死亡率。通过逻辑回归进行倾向评分匹配，对照组为肌酐清除率>90mL/min的患者，匹配比例为1:1。采用Kaplan Meier曲线分析晚期死亡率。
早期死亡率为9.4%（欧洲心脏手术风险评估系统II为4.1%）。单因素分析中，体外循环（CPB）平均时间（p=0.016）和欧洲心脏手术风险评估系统II（p=0.02）与早期死亡率相关。在多因素分析模型中，联合手术（OR 138.09；95%CI 1.82-10498.4；p=0.03）和加拿大心血管学会（CCS）3-4级（OR 70.951；95%CI 1.32-3810.11；p=0.037）是死亡预测因素。多变量分析中，CPB时间>152分钟是早期死亡的预测因素（p=0.001）。倾向评分匹配后，透析组30天、1年和晚期死亡率更高。
依赖透析的患者早期和晚期死亡率显著更高。单因素分析中死亡预测因素为CPB时间和欧洲心脏手术风险评估系统II，多因素分析中为CCS 3-4级和联合手术。
