“Blame it on the comorbidities” A 5-year follow-up of 53 chronic dialysis-dependent patients who underwent cardiac surgery

Objectives: This study evaluates mid-term survival rates and risk factors for mortality of chronic dialysis-dependent patients undergoing cardiac surgery.

Methods: Fifty-three dialysis-dependent patients (34 males, age 67 ± 12 years) with end-stage renal disease operated within March 2007 and May 2012 were analyzed retrospectively. Twenty-three patients received isolated CABG, 17 isolated valve replacement and 13 combined procedures.

Survival rates were calculated using Kaplan-Meier-methods. Predictors of mid-term survival were identified with multivariate Cox-regression analysis.

Results: Thirty-day mortality was 24.5% (n = 13). Follow-up was complete for 94.3% (n = 50).

Survival-rates at 1, 3 and 5 years were: 82, 50 and 17%, respectively.

Neither age, gender, poor EF, emergency, ECC/X-clamp-time, nor use of LITA or RITA had any influence on mid-term survival. Cause of death within mid-term follow-up period was cardiac related in 16% and related to neurological events in 16%. In the majority cause of death was associated with PAD (47%).

The only comorbidity, which could be identified as a significant risk- factor, was PAD (p = 0.035). Five patients underwent successful renal-transplantation within the follow-up period.

Conclusions: Although 30-day-mortality in this high-risk patient population was increased, mid-term survival rates were comparable to the results described in literature. Cause of death within mid-term follow-up period was mostly non-cardiac related. Predictors for enhanced 30-day mortality, like preoperative myocardial infarction, prolonged extracorporeal circulation and operation- time did not have an influence on mid-term survival.