Features of perioperative management in patients with end-stage renal disease (ESRD) requiring surgical correction of cardiovascular pathology

Aim of the study: to describe the features of perioperative management in patients with the end-stage renal disease who require surgical correction of cardiovascular pathology. Materials and methods: 20 patients with the ESRD at the age of 23 to 69 who received heart surgery assistance in the A.N. Bakulev Cardio-surgery center (NMRCCS) in years 2014 to 2017. The duration of program hemodialysis was from 2 months to 12 years. Three thirds 75 % of the patients had ischemic heart disease (IHD); other had heart valve pathology due to the progression of infective endocarditis (IE). Results: stenting of coronary arteries (CA) was performed in 14 of ischemic hard disease (IHD) patients; bypass grafting of CA was performed in 4 cases, transluminal balloon angioplasty (TBA) was performed in one case. Five patients underwent heart surgery interventions involving cardiopulmonary bypass (CB) in regard to the isolated valve pathology. Preoperative preparation procedures included correction of anemia, hypoalbuminemia, water balance, fluid and electrolyte balance disorders, normalization of arterial pressure and procedures of renal replacement therapy (RRT). "Open" heart surgery interventions were performed with combined anesthesia. Anesthesia tactics was aimed to maintaining of heart ejection, central hemodynamic parameters and volume status; ultrafiltration was applied to the patients with anuria. In the post-operative period patients underwent RRT after "open" heart surgery interventions, beginning from the second post-operative day, while patients after endovascular interventions - within the first hours after the operation. Nobody died during the observation. Conclusion: treatment of patients with the ESRD on program hemodialysis who need cardiac surgical interventions is a complex and difficult problem. However, the ESRD should not be considered as a contraindication for surgical intervention.

терминальная стадия хронической болезни почек, программный гемодиализ, периоперационное ведение, кардиохирургия, end-stage of chronic kidney disease, program hemodialysis, perioperative surveillance, cardiosurgery

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