Outcomes of Minimally Invasive Cardiac Surgery in Dialysis-Dependent Patients
Ahmed Alnajar1, Subhasis Chatterjee, MD2, Lauren Gray2, Jacqueline Olive2, Mahmut Kaymakc3, Qianzi Zhang2, Zachary D. Gray2, Joseph Lamelas, MD1.
1University of Miami, Miami, FL, USA, 2Baylor College of Medicine, Houston, TX, USA, 3Marmara University, Istanbul, Turkey.
Dialysis-dependent end stage renal disease (ESRD) is a well-recognized high risk factor for cardiac surgery with reported mortality rates of 20% following open sternotomy and 14% after transcathter procedures. We investigated ESRD outcomes in minimally invasive cardiac surgery.
From January 2017 to August 2018, data were obtained from 425 patients who underwent minimally invasive cardiac surgery with 24 (5.6%; mean age 55±14 years; 63% male [15/24]) on dialysis for a median of 25 months preoperatively (interquartile range [IQR] 1-60 months). These 24 operations comprised 4 (17%) MIDCAB procedures, 12 (50%) isolated valve operations, and 8 (33%) double valve operations (Table). Reoperations were 25% (6/24) with 1 transcatheter mitral valve replacement performed via right minithoracotomy. Elective and urgent operation rates were 75% and 25%, respectively.
The in-hospital operative mortality was 4% (1/24). Median intensive care unit and hospital length of stay were 2 days (IQR 1-5 d) and 6 days (IQR 3-15 d), respectively. Median initial ventilation time was 12 hours (IQR 6-17 h). Postoperative stroke, respiratory failure, low cardiac output, and infection occurred in 8%, 8%, 17%, and 13% of patients, respectively. Thirty-day survival was 100%, and actuarial survival at 5, 10, and 15 months was 91%, 73%, and 73%, respectively (Figure 1).
The outcomes of minimally invasive cardiac surgery in this high-risk group were more favorable than expected. Compared the sternotomy and transcatheter approaches, minimally invasive surgical options should be considered for dialysis patients. Futher investigation into the mechanisms behind the favorable outcomes is warranted.
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