[Indication and timing of surgical intervention for cardiovascular disease in hemodialysis dependent patients]

Abstract

Surgical intervention on cardiovascular disorders in patients with hemodialysis dependent renal failure improves their life expectancy, but carries high surgical mortality. Decision on the indication of surgery as well as on its timing has crucial impact on surgical outcome. We retrospectively analyzed the data of 21 hemodialysis dependent patients who had undergone cardiovascular surgery in our institution from May 2001 to May 2005 to elucidate the appropriate indication and timing of surgical intervention. The study revealed early mortality (< 30 days) of 4.8% and 5 year survival rate of 83.5%. Risk factors for poor prognosis were older age, and longer hemodialysis history. Despite the opinions advocating early surgery in these patients, we adopted a surgical strategy to wait until patients' condition is optimized. Low surgical mortality and high long-term survival of our surgical series indicated appropriateness of our strategy on the timing of surgery. However, extremely low long-term mortality rate raised the concern that our surgical indication might have been too conservative.