Krauchuk Alena, Hrapkowicz Tomasz, Suwalski Piotr, Perek Bartłomiej, Jasiński Marek, Hirnle Tomasz, Nadziakiewicz Paweł, Knapik Piotr
Department of Anesthesiology and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Ann Med Surg (Lond). 2025 Jul 23;87(8):4728-4734. doi: 10.1097/MS9.0000000000003488. eCollection 2025 Aug.
Patients with advanced-stage chronic renal failure have poor outcomes following cardiac surgery. Our registry study aimed to compare postoperative and follow-up data between patients who underwent isolated coronary artery surgery with preoperative chronic dialysis and patients with preoperative severe renal impairment who did not require chronic dialysis.
We analyzed 157 948 consecutive adult patients in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry) scheduled for isolated coronary artery surgery between January 2010 and December 2023. Overall, in this cohort, 938 patients underwent chronic dialysis (CD group), and 13 253 patients had severe renal impairment but did not undergo CD (serious renal impairment [SRI] group). Patients in these groups constituted 0.6% and 8.4% of the entire population, respectively. Preoperative data, major postoperative complications, hospital mortality, and mid-term all-cause mortality were compared among patients in CD group and SRI group.
Mean age of patients CD group and SRI group was 63.3 ± 9.5 vs. 71.9 ± 8.4 years, respectively ( < 0.001), while the mean EuroSCORE II score in these groups was 4.85% ± 7.03% vs. 5.82% ± 7.76%, respectively ( < 0.001). In-hospital mortality among patients in the CD and SRI groups were 10.9% and 6.3%, respectively ( < 0.001). Patients with preoperative CD had more frequent respiratory complications and reoperations for bleeding. The long-term mortality was also significantly higher in CD group ( < 0.001).
Patients with CD had higher in-hospital and long-term mortality rates than those with a preoperative SRI. It is possible that the EuroSCORE II underestimates the risk of coronary bypass grafting in a group of patients with chronic dialysis. It is possible that the coagulation disorders may play role in the higher mortality rates in patients undergoing chronic dialysis.
晚期慢性肾衰竭患者心脏手术后预后较差。我们的登记研究旨在比较术前接受慢性透析的单纯冠状动脉手术患者与术前有严重肾功能损害但不需要慢性透析的患者的术后及随访数据。
我们分析了2010年1月至2023年12月期间波兰国家心脏外科手术登记处（KROK登记处）计划进行单纯冠状动脉手术的157948例连续成年患者。总体而言，在该队列中，938例患者接受了慢性透析（CD组），13253例患者有严重肾功能损害但未接受慢性透析（严重肾功能损害[SRI]组）。这些组中的患者分别占整个人口的0.6%和8.4%。比较了CD组和SRI组患者的术前数据、主要术后并发症、医院死亡率和中期全因死亡率。
CD组和SRI组患者的平均年龄分别为63.3±9.5岁和71.9±8.4岁（P<0.001），而这些组中的平均欧洲心脏手术风险评估系统（EuroSCORE）II评分分别为4.85%±7.03%和5.82%±7.76%（P<0.001）。CD组和SRI组患者的院内死亡率分别为10.9%和6.3%（P<0.001）。术前接受慢性透析的患者呼吸并发症和因出血再次手术的情况更频繁。CD组的长期死亡率也显著更高（P<0.001）。
与术前有严重肾功能损害的患者相比，接受慢性透析的患者院内和长期死亡率更高。欧洲心脏手术风险评估系统II可能低估了慢性透析患者群体中冠状动脉搭桥手术的风险。凝血障碍可能在接受慢性透析患者的较高死亡率中起作用。
