Cardiac Surgery in Patients With Moderate Renal Impairment
Cardiac Surgery in Patients With Moderate Renal Impairment
Background. There is a paucity of information concerning the results of cardiac surgery in patients with moderate impairment of renal function. We reviewed our recent experience to determine the results of operation and the long-term outcome.
Methods. Since January 1992, we have performed cardiac surgical procedures utilizing total cardiopulmonary bypass on 57 adult patients with preoperative serum creatinine values ≥2.0 mg/dL and no history of dialysis. Operative procedures done were coronary artery bypass (39 patients), repeated coronary artery bypass (2), valve replacement with or without coronary artery bypass (12), and other procedures (4).
Results. No operative deaths occurred. There were 3 hospital deaths. Only 5 patients required perioperative dialysis; in 5 additional patients, chronic dialysis was begun from 4 to 24 months postoperatively. The surviving patients who were not receiving dialysis had a mean creatinine value of 2.4 mg/dL at most recent follow-up.
Conclusions. Adult patients with moderate renal impairment can safely have major cardiac procedures. The majority of patients maintain stable renal function postoperatively. The overall results of cardiac surgery in this patient population are good.
Cardiopulmonary bypass brings a multitude of physiologic changes that may affect short-term and long-term function of many organs, including renal function. Special concerns in patients with renal impairment include acid-base balance, hyperkalemia, volume overload, and clotting abnormalities. All of these have major implications for patients having cardiac surgical procedures. Numerous publications have elucidated the results of cardiac surgery in patients with chronic renal failure requiring dialysis. In contrast, there is a paucity of information concerning the results of operation in those patients with moderate impairment of renal function. We reviewed our experience with cardiac surgery in adult patients with compromised preoperative renal function to determine both the results of operation and the long-term outcome in terms of renal function postoperatively.
Background. There is a paucity of information concerning the results of cardiac surgery in patients with moderate impairment of renal function. We reviewed our recent experience to determine the results of operation and the long-term outcome.
Methods. Since January 1992, we have performed cardiac surgical procedures utilizing total cardiopulmonary bypass on 57 adult patients with preoperative serum creatinine values ≥2.0 mg/dL and no history of dialysis. Operative procedures done were coronary artery bypass (39 patients), repeated coronary artery bypass (2), valve replacement with or without coronary artery bypass (12), and other procedures (4).
Results. No operative deaths occurred. There were 3 hospital deaths. Only 5 patients required perioperative dialysis; in 5 additional patients, chronic dialysis was begun from 4 to 24 months postoperatively. The surviving patients who were not receiving dialysis had a mean creatinine value of 2.4 mg/dL at most recent follow-up.
Conclusions. Adult patients with moderate renal impairment can safely have major cardiac procedures. The majority of patients maintain stable renal function postoperatively. The overall results of cardiac surgery in this patient population are good.
Cardiopulmonary bypass brings a multitude of physiologic changes that may affect short-term and long-term function of many organs, including renal function. Special concerns in patients with renal impairment include acid-base balance, hyperkalemia, volume overload, and clotting abnormalities. All of these have major implications for patients having cardiac surgical procedures. Numerous publications have elucidated the results of cardiac surgery in patients with chronic renal failure requiring dialysis. In contrast, there is a paucity of information concerning the results of operation in those patients with moderate impairment of renal function. We reviewed our experience with cardiac surgery in adult patients with compromised preoperative renal function to determine both the results of operation and the long-term outcome in terms of renal function postoperatively.
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