• I Durmaz, S Büket, Y Atay, T Yağdi, M Ozbaran, M Boğa, I Alat, A Güzelant, and S Başarir.
• Ege University Medical Faculty, Department of Cardiovascular Surgery, Izmir, Turkey.
• J. Thorac. Cardiovasc. Surg. 1999 Aug 1;118(2):306-15.

ObjectiveRenal failure is known to increase the morbidity and mortality in patients undergoing cardiac surgery. The results of heart surgery in patients with non-dialysis-dependent, mild renal insufficiency are not clear.MethodsOne hundred nineteen adult patients with chronic renal failure underwent cardiac surgery. Group I consisted of 93 patients who had creatinine levels between 1.6 and 2.5 mg/dL but who were not supported by dialysis. Group II consisted of 18 patients with creatinine levels higher than 2.5 mg/dL who were not supported by dialysis. Group III consisted of 8 patients with end-stage renal disease who were receiving hemodialysis.ResultsThe hospital mortality rates were 11.8%, 33.0%, and 12.5%, respectively. Morbidity was 21.5%, 44.4%, and 75.0%, respectively, in groups I, II, and III. Postoperative hemodialysis was needed in 2 (2.15%) patients from group I and 6 (33%) patients from group II. On multivariable logistic regression analysis, risk factors for mortality were preoperative creatinine level more than 2.5 mg/dL, angina class III-IV, emergency operation, excessive mediastinal hemorrhage, postoperative pulmonary insufficiency, low cardiac output, and rhythm disturbances. Risk factors for morbidity were preoperative creatinine level more than 2.5 mg/dL and postoperative dialysis.ConclusionsChronic renal failure increases the mortality and morbidity in patients undergoing cardiac surgery. Renal insufficiency with creatinine levels higher than 2.5 mg/dL increases the risk of postoperative dialysis and prolongs the length of hospital stay. Careful preoperative management and intraoperative techniques, such as avoiding low perfusion pressure and using low-dose dopamine, may be useful for a good operative outcome.

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