Cardiac surgery in hemodialysis patients

Five hemodialysis patients have undergone cardiac procedures between March 1986 and August 1992. These cases include two coronary artery bypass operations and three valve replacements. The average time on dialysis prior to surgery was 67 months and all patients were in NYHA grade 3 or 4. All patients were dialyzed two or three consecutive days before surgery. Intraoperative extracorporeal ultrafiltration method (ECUM) was used in all patients. In one patients hemodialysis was also performed intraoperatively in addition to ECUM. All patients received platelet transfusions after cardiopulmonary bypass because of known platelet dysfunction and coagulation problems in renal failure patients. Our first patient, who had been dialyzed on operative day using regional heparinization, returned operating room for bleeding on the first postoperative day, then in another four patients hemodialysis was begun on the first or second postoperative day using nafamostat mesilate as anticoagulant. No perioperative deaths occurred and all patients remain alive with a mean follow-up of 28 months. In summary, cardiac surgery can be successfully carried out on five chronic hemodialysis patients, hemodialysis can be performed safely on early postoperative day, and nafamostat mesilate is a useful anticoagulation agent to prevent postoperative bleeding complications.