Early and long-term results of cardiac surgery in dialysis patients.

Cardiac surgery in patients receiving dialysis has a high mortality and morbidity. Early long-term results have been analysed following various cardiac operative procedures. Between 1981 and 1992, 40 patients, of mean age 55.7 (range 31-71) years underwent cardiac surgery. Procedures included coronary artery bypass grafting (20 patients), aortic valve replacement (six), mitral valve replacement (four), aortic valve or mitral valve plus coronary artery bypass grafting (one each), aortic plus mitral valves (two), heart and renal transplantation (one each), atrial septal defect closure (one) and pericardial decortication (three). Before surgery, patients were in the New York Heart Association (NYHA) classes II (5%), III (52.2%) and IV (42.5%). The operative mortality rate was 15%; survivors were in NYHA classes I (3%), II (88.2%) and III (8.8%). There were 11 late deaths. Follow-up at a mean of 35 (range 1-93) months showed actuarial survival rates of 91% (1 year) and 69% (5 years). After coronary artery bypass grafting, survival rates were 95% (1 year) and 72% (5 years). Survivors were in NYHA classes I (4.7%), II (85.5%) and III (9.5%). Cardiac surgery in dialysis patients is associated with an acceptable hospital mortality; quality of life in long-term survivors is increased. Hence, surgical treatment is advocated in patients with symptomatic heart disease. Early diagnosis and surgical intervention in NYHA class II patients may lead to a lower perioperative mortality.