[Evaluation of surgical treatment of mitral valve defect in patients with chronic renal failure].

Unlabelled: Renal failure of patients qualified for open-heart surgical treatment seems to be very important problem since years. The operation with extracorporeal circulation is large burden for kidneys and there is huge risk of intensifying of existing failure. The aim of the study was the evaluation of renal parameters, complications occurrence and mortality of patients with chronic renal failure (ChRF) (grade II--mild ChRF) subjected to mitral valve replacement.

Materials And Methods: To retro- and prospective analysis were subjected 34 patients with severe mitral valve defect, subjected to operation between 1998 and 2002 in Department of Cardiac Surgery in Lodz. All patients included to study had increased level of creatinine--1, 5-3, 0 mg/dl (at least in three measurements). All examined patients were subjected to artificial mitral valve replacement and 13 patients to simultaneous tricuspid valve plastic surgery. Postoperative evaluation of clinical condition and renal parameters was performed twice: early (till 30 day after operation) and long-term (after meanly 14 months).

Results: In seven patients, in early postoperative period, it was necessary to implement extracorporeal dialysis with artificial kidney dialysis machine. Among these patients we ascertained three deaths (intrahospital mortality was 8.8%). During long-term observation we noted two cases of infective endocarditis requiring reoperation and re-implantation of mitral valve. During this time of observation only one death was noted (post-hospital mortality was 3.2%).

Conclusions: Dysfunction of kidneys, even in mild degree, causes significant increase of risk of early death (about 2.5 times). In most research population in long-term observation we ascertained the large improvement of kidney functions (significant decrease of creatinine level; p < 0.001). Concomitant tricuspid valve regurgitation, requiring plastic surgery is an additional factor incriminating long-term results of surgical treatment.