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

Hasanga Jayasekera, Nigel Pinto, Julie Mundy, Annabel Wood, Elaine Beller, Rayleene Griffin, Paul Peters, Pallav Shah

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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.

Original languageEnglish
Pages (from-to)105-10
Number of pages6
JournalHeart Lung and Circulation
Volume20
Issue number2
DOIs
Publication statusPublished - Feb 2011
Externally publishedYes

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Thoracic Surgery
Dialysis
Quality of Life
Lung
Transplants
Mortality
Morbidity
Survival
Sex Ratio
Aortic Valve
Coronary Artery Bypass
Blood Transfusion
Renal Insufficiency
Interviews
Kidney
Health

Cite this

Jayasekera, Hasanga ; Pinto, Nigel ; Mundy, Julie ; Wood, Annabel ; Beller, Elaine ; Griffin, Rayleene ; Peters, Paul ; Shah, Pallav. / Cardiac surgery in the presence of dialysis : Effect on mid-term outcomes and quality of life. In: Heart Lung and Circulation. 2011 ; Vol. 20, No. 2. pp. 105-10.
@article{7082146cb97643968b8290d2fb3f327e,
title = "Cardiac surgery in the presence of dialysis: Effect on mid-term outcomes and quality of life",
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.",
author = "Hasanga Jayasekera and Nigel Pinto and Julie Mundy and Annabel Wood and Elaine Beller and Rayleene Griffin and Paul Peters and Pallav Shah",
note = "2010 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. All rights reserved.",
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Jayasekera, H, Pinto, N, Mundy, J, Wood, A, Beller, E, Griffin, R, Peters, P & Shah, P 2011, 'Cardiac surgery in the presence of dialysis: Effect on mid-term outcomes and quality of life' Heart Lung and Circulation, vol. 20, no. 2, pp. 105-10. https://doi.org/10.1016/j.hlc.2010.10.005

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; Shah, Pallav.

In: Heart Lung and Circulation, Vol. 20, No. 2, 02.2011, p. 105-10.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Cardiac surgery in the presence of dialysis

T2 - Effect on mid-term outcomes and quality of life

AU - Jayasekera, Hasanga

AU - Pinto, Nigel

AU - Mundy, Julie

AU - Wood, Annabel

AU - Beller, Elaine

AU - Griffin, Rayleene

AU - Peters, Paul

AU - Shah, Pallav

N1 - 2010 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. All rights reserved.

PY - 2011/2

Y1 - 2011/2

N2 - 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.

AB - 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.

U2 - 10.1016/j.hlc.2010.10.005

DO - 10.1016/j.hlc.2010.10.005

M3 - Article

VL - 20

SP - 105

EP - 110

JO - Asia Pacific Heart Journal

JF - Asia Pacific Heart Journal

SN - 1444-2892

IS - 2

ER -