Early and late outcomes of cardiac surgery in patients with moderate to severe preoperative renal dysfunction without dialysis (original) (raw)
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Interactive cardiovascular and thoracic surgery, 2007
Acute renal failure requiring continuous renal replacement therapy post cardiac surgery carries a high mortality. Most studies have focused on patients with impaired renal function preoperatively but little is known about predictors of such a complication in patients with preoperatively normal renal function. This is a retrospective review of a prospective collected database. A total of 1609 patients underwent cardiac surgery over a 4-year period. Dialysis was required in 47 patients (2.9%). Univariate analysis identified the following as significant risk factors: age, female gender, chronic obstructive pulmonary disease, congestive cardiac failure, creatinine clearance, Euro, Parsonnet and Cleveland clinic scores, body mass index, non-isolated CABG, cardiopulmonary bypass time, extubation time and pulmonary complications (P<0.05). Multivariate analysis identified EuroSCORE, congestive cardiac failure, insulin-dependent diabetes, emergency surgery, postoperative extubation time a...
European Journal of Cardio-Thoracic Surgery, 2008
Objectives: To assess the impact of preoperative renal dysfunction on in-hospital mortality and late survival outcome following adult cardiac surgery. Methods: Prospectively collected data were analysed on 7621 consecutive patients not requiring preoperative renal-replacement therapy, who underwent CABG, valve surgery or combined procedures from 1/1/98 to 1/12/06. Preoperative estimated glomerular filtration rate was calculated using Cockcroft-Gault formula. Patients were classified in the four chronic kidney disease (CKD) stage classes defined by the National Kidney Foundation Disease Outcome Quality Initiative Advisory Board. Late survival data were obtained from the UK Central Cardiac Audit Database. Results: There were 243 in-hospital deaths (3.2%). There was a stepwise increase in operative mortality with each CKD class independent of the type of surgery. Multivariate analysis confirmed CKD class to be an independent predictor of in-hospital mortality (class 2 OR 1.45, 95% CI 1.1-2.35, p = 0.001; class 3 OR 2.8, 95% CI 1.68-4.46, p = 0.0001; class 4 OR 7.5, 95% CI 3.76-15.2, p = 0.0001). The median followup after surgery was 42 months (IQR 18-74) and there were 728 late deaths. Survival analysis using a Cox regression model confirmed CKD class to be an independent predictor of late survival (class 2 HR 1.2, 95% CI 1.1-1.6, p = 0.0001; class 3 HR 1.95, 95% CI 1.6-2.4, p = 0.0001; and class 4 HR 3.2, 95% CI 2.2-4.6, p = 0.0001). Ninety-eight percent (7517/7621) of patients had a preoperative creatinine <200 mmol/l, which is not included as a risk factor in most risk stratification systems. Conclusions: Mild renal dysfunction is an important independent predictor of in-hospital and late mortality in adult patients undergoing cardiac surgery. #
International Journal of Surgery, 2011
Objectives: Although previous studies have shown increased mortality in renal dysfunction patients undergoing cardiac surgery, there is lack of data on the pattern of postoperative complications that occur in such patients and their distribution among dialysis and non-dialysis dependent renal dysfunction. Methods: This is a retrospective review of prospectively collected data over 8 year period of cardiac surgery patients. Our cohort consisted of 3598 consecutive patients divided into: normal kidneys (n ¼ 3276, 91%), renal dysfunction (n ¼ 277, 8%) and dialysis (n ¼ 45, 1%). Postoperative complications and mortality were analysed. Multivariate analysis was conducted to adjust for the potential confounders in the association between renal dysfunction and postoperative complications. Results: Univariate analysis showed increased risk of the following complications among renal dysfunction and dialysis patients: low cardiac output, arrhythmias, reoperation, prolonged ventilation, readmission to intensive care, blood transfusion and prolonged hospital stay. Mortality rate was highest in dialysis patients compared to renal dysfunction and normal kidney patients (11% vs. 7% vs. 3%, respectively p-value <0.001). Multivariate analysis showed that renal dysfunction with or without dialysis is an independent predictor of postoperative low cardiac output, blood transfusion, prolonged ventilation, and mortality. The odd ratios were higher for dialysis than non-dialysis dependent patients. This effect persisted after adjusting for potential confounders such as age and gender. Conclusion: The presence of renal dysfunction preoperatively increases the rate of postoperative complications and mortality following cardiac surgery. Prior knowledge of these complications can help in developing preventative strategies to reduce the associated risk.
Does the Stage of Chronic Kidney Failure Influence the Outcome in Cardiac Surgery?
Advances in Clinical and Experimental Medicine, 2015
Background. The number of patients with chronic kidney failure requiring cardiac surgery is continuously increasing. Additionally, significant worsening in the overall risk profile of this group of patients is noted. Objectives. To investigate the effect of chronic renal dysfunction both in non-dialysis-dependent renal failure and end-stage renal failure patients, on early mortality-morbidity and late survival in a series of cardiac surgery patients at our institution. Material and Methods. 1344 patients who had open heart surgery at our university hospital between 2010 and 2013 were retrospectively reviewed. Chronic renal dysfunction was defined according to preoperative glomerular filtration rate. Patients selection (n = 80). Group 1 mild-(GRF 59-30 mL/min), Group 2 moderate-(GFR 29-15 mL/min), Group 3 end stage-(GFR < 15 mL/min) renal failure. Results. Chronic renal dysfunction was present in 5.95 % of all patients studied. Group 1-55 (68.75%), Group 2-16 (20%), Group 3-9 (11.25%). No difference between the groups in the need for heart inotropic support was noted; however the use of these medications was necessary in 60.6% of all studied patients. Forty nine percent in Group 1, 87.5% in Group 2 and 77% in Group 3, respectively. Renal replacement therapy in the early postoperative period was needed in 12 patients, with significance between the groups (p = 0.001). The overall hospital mortality was 2.5%. Follow-up was completed with a mean of 1.4 years (range 2 months to 4 years). There were 6 (7.5%) late deaths. Conclusions. Our observations do not exhibit large variations in postoperative complications and deaths in patients with chronic renal failure, depending on the degree of preoperative renal function impairment. It seems that renal failure regardless of the degree of impairment is a factor aggravating the intra and post-operative course in cardiac surgery patients (Adv Clin Exp Med 2015, 24, 5, 845-850).
The Impact of Non-Dialysis-Dependent Renal Dysfunction on Outcome Following Cardiac Surgery
The Heart Surgery Forum, 2011
Background: We evaluated the results of different types of cardiovascular surgery in patients with chronic renal failure (CRF) (serum creatinine ≥ 2 mg/dL) who were not dialysisdependent. Methods: Eighty-two patients who presented with nondialysis-dependent CRF were retrospectively evaluated. Patients in Group 1 (n = 12) underwent valvular surgery, those in Group 2 (n = 58) underwent coronary artery bypass grafting (CABG), and those in Group 3 (n = 12) underwent combined CABG and valvular surgery. Results: The demographics were similar among the groups. Cardiopulmonary bypass and aortic cross-clamping times were shorter (P < .01), the use of blood and blood products was less, and the mechanical ventilation time and hospital stay were shorter in Group 2 in comparison to the other groups (P < .01). There were 4 (6.9%) early mortalities in Group 2. Late mortalities occurred in 4 (33.3%), 16 (27.6%), and 6 (50%) patients from Groups 1, 2, and 3, respectively. Cox regression analysis revealed that age, the presence of a preoperative cerebrovascular accident, the presence of a left main coronary lesion, preoperative blood urea nitrogen level, and the use of blood and blood products were independent risk factors for early mortality. High Euroscore, cerebrovascular accident, the use of platelet suspension, longer ventilation support times, and combined CABG and valvular surgery were independent risk factors for late mortality. Conclusions: Morbidity and survival seemed to be more dependent on preoperative patient characteristics than the type of surgery in this group of patients. Combined CABG and valvular surgery was a risk factor for late mortality.
Outcomes of cardiac surgery in chronic kidney disease
The Journal of Thoracic and Cardiovascular Surgery, 2014
Objective: To identify predictors of early and late outcomes of cardiac surgery in patients with chronic kidney disease. Methods: Patients (n ¼ 545) with serum creatinine !200 mmol/L or renal dialysis were identified from databases maintained by the largest Sydney cardiothoracic surgical units with data consistent with the Australian and New Zealand Society of Cardiothoracic Surgeons data definitions. The patient data were matched against the National Dialysis Database and the New South Wales Register of Births, Deaths, and Marriages. Statistical analysis was used to identify predictors of early and late outcomes. Results: The Kaplan-Meier estimate of 1-, 5-, and 10-year survival for all patients was 78%, 56%, and 36%, respectively. The outcomes were similar after coronary bypass surgery and valve replacement and were also similar for dialysis and nondialysis patients. The odds ratios for the significant independent predictors of outcomes were, for perioperative death, age (1.4 per decade), emergency surgery (7.0), redo surgery (3.8), left ventricular impairment (moderate, 2.7; severe, 4.4); for new early postoperative dialysis, estimated glomerular filtration rate<20 mL/min (3.8), emergency surgery (2.7), tricuspid valve surgery (4.4); for new permanent dialysis within 6 months of surgery, serum estimated glomerular filtration rate<20 mL/min (odds ratio, 4.6). The hazard ratio for the independent predictors of late death in those alive 6 months after surgery was 1.4 per decade for age and 1.4 for moderate or severe left ventricular impairment. Conclusions: Left ventricular impairment is a risk factor for perioperative and late death in patients with kidney disease. After cardiac surgery, preoperative dialysis-dependent and dialysis-free patients had similar long-term outcomes.