[Cardiac surgery in renal transplant patients. Apropos of 24 cases].

UNLABELLED: Results of cardiac surgery in renal transplant patients are not well documented. Immunosuppression as well as associated conditions in these patients, and the increased susceptibility of the renal allograft to the extracorporeal circulation (ECC) may alter the prognosis of renal transplant patients submitted to cardiac surgery. To evaluate this hypothesis, we reviewed the files of 24 patients (18 Male, 6 Female; age: 49 +/- 12 years) operated under ECC between 1978 and 1997. Twenty patients underwent coronary artery bypass surgery, 5 patients a valve replacement procedure (aortic and/or mitral), and one patient necessitated a Cabrol procedure for an ascending aorta aneurysm. Preoperatively, the majority of patients were in functional class (NYHA) IV (16 patients), and ejection fraction was > 50% in 18 patients. Two operative deaths secondary to cardiogenic shock were encountered. Five patients (23%) were reoperated for bleeding; 5 patients (23%) sustained a major infection (2 pneumonias, 2 mediastinitis and one wound infection) resulting in death in one patient; 5 patients (23%) were treated for arythmia; and 2 patients (9%) suffered a perioperative myocardial infarction. Serum creatinine levels did not increase significantly during hospitalization (p = 0.41 between extreme values). Mean follow-up (41 +/- 28 months) of the 20 survivors revealed recurrent angina in 5 patients and late death in 4 patients, cardiac-related in 3 cases.

CONCLUSION

Cardiac surgery in renal transplant patients is subjected to a high morbidity and mortality. Mid-term prognosis is reserved especially in presence of associated conditions.