Autor:

Bories J, Rosendahl U, Albert A, Dalladaku F, Bauer S, Ennker J

Erscheinungsort:

Thorac Cardiovase Surg 2002; 50 Suppl. 1: S30-32
© Georg Thieme Verlag Stuttgart - New York. ISSN 0946-4778

Inhalt:

Division of Cardiothoracic Surgery, Heart Institute Lahr/ Baden, Germany

Objective: Cardiac events frequently cause death and hospitalisation, in pts with end stage renal failure (ESRF). In this study we wanted to review the results of cardiosurgical treatment in high risk pts with ESRF by outcome and predictability at our institution.

Methods: 41 consecutive patients undergoing 42 procedures from 1996 through 2001 were retrospectively analysed. Follow-up information was obtained from the referring dialysis centers by a questionnaire. Mean follow-up was 28 month (1-60). In addition, Euroscore values were calculated for these pts. In-hospital mortality was compared with the outcome of all pts. without ESRF undergoing cardiac surgery at our institution within the same period (n = 8916).

Results: 41 patients, mean age 65 yr (47-80), 11 female= 27% had 42 procedures (27 = 64% coronary artery bypass, 9 = 21 % valve replace-ment, 6=14% combined). In-hospital mortality was 6/41 = 14.3%, 3/27 = 11.1 % for isolated CABG. Co-morbidity was high (37% preoperative MI, 34% with diabetes, hypertension and hyperlipidaemia/ peripheral vascular disease). Mean Euro-score value was 7.92 (3-19). Out of 8916 pts. without ESRF undergoing surgery those with Euroscores > 6 showed an in-hospital mortality of 4.1%. 18 additional pts with ESRF = 43.9% died within the follow-up period (cardio-vascular deaths 10=56%, other reasons 4=22%, unknown 4=22%). Mean preoperative CCS angina class in CAD patients (22/ 27 = 81.5%) was 2.7 (0-4), all of the surviving patients with angina had full symptomatic relief.

Conclusion: Currently procedures in multimorbid patients with ESRF can be done with reasonably elevated risks. Overall survival might not be improved, but relief of angina definetely is. The Euroscore considerably underestimates the perioperative risk of pts. with ESRF undergoing cardiac surgery and is therefore invalid in this subset.