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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2003 Dicembre;44(6):725-30

lingua: Inglese

Cardiac surgery in patients receiving long term hemodialysis. Short and long term results

Jault F., Rama A., Bonnet N., Reagan M., Nectoux M., Petitclerc T., Pavie A., Gandjbakhch I.

Division of Thoracic ­and Cardiovascular Surgery Pitié’s Hospital of Paris, Paris, France


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Aim. Cardiac sur­gery car­ries a ­high ­risk in hemo­di­al­y­sis ­patients ­and ­has ­been ques­tioned ­for ­its ­results; ­the pur­pose of ­this ­study is to ­focus on ­the ­short ­and ­long ­term ­results in ­our insti­tu­tion.
Methods. We ret­ro­spec­tive­ly ana­lyzed ­the ­data ­from 124 hemo­di­al­y­sis ­patients ­who under­went car­diac sur­gery in ­our ­unit ­between January 1980 ­and December 1998; 14.5% ­were dia­bet­ic; 46% ­had iso­lat­ed cor­o­nary ­artery dis­ease (­group 1); 29.8% ­had val­vu­lar dis­ease ­alone (­group 2); 14.5% ­valve ­and cor­o­nary dis­ease (­group 3) ­and 9.6% mis­cel­la­ne­ous dis­ease at high­est ­risk (­group 4). We ana­lyzed ­the rela­tionship ­between sev­er­al var­i­ables (­age, ­sex, hyper­ten­sion, dia­betes, pre­vi­ous myo­car­dial infarc­tion, ­type of dis­ease, pre­op­er­a­tive ejec­tion frac­tion) ­and oper­a­tive mor­tal­ity (30 ­days) ­and ­late sur­vi­val.
Results. The over­all oper­a­tive mor­tal­ity ­was 16.9%. The ­only ­risk fac­tor ­was ­the ­type of car­diac dis­ease: oper­a­tive mor­tal­ity ­was high­er in ­groups 3 ­and 4 com­bined ­than in ­groups 1 ­and 2 com­bined (30% ver­sus 12.7%, p=0.07). Ninety-­nine ­patients ­were fol­lowed ­until January 2002. Late sur­vi­val ­rate ­was 46.6±5% at 6 ­years ­for ­all ­patients, it ­was sig­nif­i­cant­ly bet­ter in ­groups 1 ­and 2 com­bined ­than in ­groups 3 ­and 4 com­bined. The ­only ­risk fac­tor ­for ­late mor­tal­ity ­was arte­ri­al hyper­ten­sion. Fifty-sev­en ­patients ­are ­still ­alive, 46 in ­groups 1 ­and 2, 11 in ­groups 3 ­and 4. Progression of cor­o­nary ­lesions ­occurred in 6 ­patients ­and val­vu­lar ­lesions in 3 ­patients. The remain­der ­are ­doing ­well.
Conclusion. Cardiac sur­gery ­seems to be jus­ti­fied by ­the sever­ity of ­the ­lesions. Its actu­al ­results ­can per­haps, be ­improved by ear­li­er detec­tion of car­diac dis­ease ­and bet­ter pre­ven­tion of myo­car­dial hyper­tro­phy ­and car­diac cal­cifi­ca­tions.

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