Perioperative managenent of patients with end-stage renal failure undergoing cardiac surgery

Abstract

Twelve patients with end-stage renal disease underwent heart operation: aorto-coronary bypass graft (ACB) in five, resection of ventricular aneurysm and the closure of septal penetrance in one, valvular replacement in two, mitral commissurotomy in two and the patch closure of atrial and/or ventricular septal defect in two. Before operation, 8 patients were maintained on hemodialysis (HD), while 4 were maintained on continuous ambulatory peritoneal dialysis (CAPD). The duration of the treatment with HD and/or PD before operation ranged from one month to III months (mean 21.8±32.3). After the operation, two patients were maintained on HD, 5 on intermittent PD (IPD) and the remaining 5 on continuous PD (CPD). During the operation, both HD and hemofiltration were performed in combination with cardio-pulmonary bypass (CPB) to control the water, electrolyte and acid-base balance and to eliminate uremic toxins. Out of 12 patients, two died of sepsis on 15 POD and low-output syndrome on 1 POD, respectively (operative death: 16.7%). In seven patients out of 10, HD was substituted for PD, and two of them died of cerebellar and gastrointestinal beeeding on 35 POD and hemorrhagic brain infarction on 51 POD, respectively. In four patients who were treated with CAPD both before and after operation, the postoperative course was very satisfactory. CAPD is considered to be a promising therapeutic modality. Additionally, intraoperative hemodialysis and hemofiltration in combination with CPB is very effective for the control of water, electrolyte and acid-base balance and the prevention of azotemia.