Cardiac surgery in the presence of dialysis: Effect on mid-term outcomes and quality of life

Jayasekera, Hasanga, Pinto, Nigel, Mundy, Julie, Wood, Annabel, Beller, Elaine, Griffin, Rayleene, Peters, Paul and Shah, Pallav (2011) Cardiac surgery in the presence of dialysis: Effect on mid-term outcomes and quality of life. Heart Lung and Circulation, 20 2: 105-110. doi:10.1016/j.hlc.2010.10.005


Author Jayasekera, Hasanga
Pinto, Nigel
Mundy, Julie
Wood, Annabel
Beller, Elaine
Griffin, Rayleene
Peters, Paul
Shah, Pallav
Title Cardiac surgery in the presence of dialysis: Effect on mid-term outcomes and quality of life
Journal name Heart Lung and Circulation   Check publisher's open access policy
ISSN 1443-9506
1444-2892
Publication date 2011-02
Year available 2010
Sub-type Article (original research)
DOI 10.1016/j.hlc.2010.10.005
Volume 20
Issue 2
Start page 105
End page 110
Total pages 6
Place of publication Chatswood, N.S.W., Australia
Publisher Elsevier Australia
Collection year 2011
Language eng
Formatted abstract
Background: This study evaluates the impact on short and mid-term outcomes and quality of life of dialysis dependent patients undergoing cardiac surgery. The benefit to patients from a bio-psycho-social perspective is put into context via an inter-personal patient interview.
Methods: The study period was from February 1999 to February 2009. Data on 45 dialysis dependent patients undergoing cardiac surgery was prospectively collected and analysed retrospectively. The mean age was 59.9 years and sex ratio (M:F) of 32:13. All patients were New York Heart Association (NYHA) class >2 preoperatively.
Fifty-five percent (25/45) of these patients had coronary artery bypass graft surgery (CABG) and 28% (12/45) aortic valve replacement surgery alone. Forty-two variables were studied to define predictors of outcome. Follow-up was 100% (18/18) with a mean follow-up time of 48.1 months (0-124 months). They were followed up with quality of life and functional coping score surveys (SF-36).
Results: The main postoperative morbidities were pulmonary complications 20% (9/45), multi-organ failure 11% (5/45) and blood transfusion rates 40% (18/45). The 30 day mortality of the dialysis patients was 13.3% (6/45) and late death was 54% (21/39). Increasing age, pulmonary complications and blood product usage were the significant predictors of both 30 day mortality (age: p = 0.02, pulmonary: p = 0.003, blood product usage: p = 0.03) and late death (age: p = 0.008, pulmonary: p = 0.02, blood product usage: p = 0.02). New York Heart Association class was I-II in 83% (15/18) on long term follow up. All five patients awaiting renal transplants received their transplant in the first six months post-operatively. The overall survival at one year was 78% and five years was 40%. On SF-36 health questionnaire all patients scored less on physical functioning than the Australian norms (24.89 ± 4.10).
Conclusions: Cardiac surgery in the presence of renal failure is associated with significant morbidity and mortality. The overall survival and quality of life of dialysis patients undergoing cardiac surgery is poor.
© 2010 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand.
Keyword Cardiac surgery
Dialysis
Outcome
Quality of life
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Available online 12 November 2010.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Public Health Publications
 
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Created: Sun, 06 Mar 2011, 00:12:53 EST