Risk factors for open heart surgery in hemodialysis patients

Abstract

There have been many reports on open heart surgery in hemodialysis patients; however, the mortality rates in these patients are higher than those in nonhemodialysis patients. The purpose of this study was to identify the risk factors for mortality following open heart surgery in hemodialysis patients. We evaluated 76 consecutive patients (76/2030 total open heart surgeries, 3.7%) who required hemodialysis before open heart surgery between January 1990 and January 2008. There were 46 men and 30 women (mean age 63 +/- 11 years). The mean duration of hemodialysis was 9 years 5 months (8 months to 30 years). Chronic glomerulonephritis (25 cases, 33%) and diabetic nephropathy (17 cases, 22%) were the most common diseases leading to a requirement for hemodialysis. Operations included 36 coronary artery bypass grafting (CABG) cases (48%; emergency/elective 22: 14), 24 aortic valve replacements (AVR) (34%), and 9 cases of concomitant AVR plus CABG (12%). Multivariate logistic analyses were performed to identify the risk factors. No patient was lost during follow-up. The overall in-hospital mortality rate was 17.1% (13/76). The 5-year survival rate was 39% +/- 8%. Univariate logistic analysis showed that age (>70 years), low-output syndrome (ejection fraction <40% and/or intraaortic balloon pump support), and concomitant surgery were significant risk factors for mortality. Multivariate logistic analysis suggested that only concomitant surgery was the significant risk factor (odds ratio 4.37, P = 0.007). Concomitant surgery is a significant risk factor for mortality following open heart surgery in hemodialysis patients.