Cardiac surgical treatment of the patients with renal insufficiency.

Cardiac surgical treatment of the patients with renal insufficiency became more frequent necessity. Also postoperative renal insufficiency occurs pretty often after cardiac surgery. That is in part a result of broadening of operative indications, which might concern patients with multiple diseases. Patients with renal insufficiency and coexistent heart diseases, patients with endocarditis and patients with renal insufficiency after cardiac surgery require the treatment of cardiac surgeons and nephrologists. Heart diseases are the main cause of the mortality in the dialysis patients. Among the patients with renal diseases the cardiac surgeon most often receive long-term dialysis patients with coexistent heart diseases, who needs cardiac surgery (coronary artery by-pass grafting, valve operations). The amount of these operations increases, however it does not exceed 1% of overall number of cardiac operations. This group however, is very exacting and carries a high operative risk. Dialysis patients are exposed to increased risk of infection. 75% of them reveal infections in the form of sepsis. The presence of bacteria in the bloodstream increase the risk of infectious endocarditis. 6% of dialysis patients with IE require surgery. The prevention of renal failure after cardiac surgery is also very important. Renal insufficiency occurs in 12% of patients after cardiac surgery with the use of extracorporeal circulation. Renal failure complicates postoperative course and is of high risk for the patient. The mortality due to acute postoperative renal failure, which requires hemofiltration, reaches 70%. The proper cardiac surgical and nephrological management of renal insufficiency in patients selected for cardiac surgery as well as in patients with postoperative renal insufficiency is necessary to obtain good operative results.