Acute Kidney Injury after Heart Valve Surgery in Elderly Patients: any Risk Factors to Modify?

Carrascal, Yolanda; Laguna, Gregorio; Blanco, Miriam; Pañeda, Lucía; Segura, Bárbara

doi:10.21470/1678-9741-2019-0483

Cited by 11 publications

(7 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As a major complication of on-pump cardiac surgeries, acute kidney injury (AKI) due to ischemia-reperfusion injury is associated with increased mortality and morbidity [18]. Age is an independent risk factor for AKI related to cardiac surgery, especially in patients older than 70 years (RR:1.79, 95% CI:1.17-2.72) [19]. In the present study focusing on patients over 70 years, the eGFR of the DNC group was higher than the CBC group immediately after surgery.…”

Section: Discussionmentioning

confidence: 99%

Del-Nido cardioplegia in cardiac surgery for elderly patients: a propensity score-matched analysis

Qing

Luo

et al. 2023

J Cardiothorac Surg

View full text Add to dashboard Cite

Objectives To compare the safety and efficacy of del-Nido cardioplegia (DNC) with traditional 4:1 cold blood cardioplegia (CBC) in coronary artery bypass grafting and/or valve surgeries in elderly patients. Methods The present study is a retrospective case-series study that included 302 consecutive patients aged 70 years and over who underwent on-pump valve surgery and/or coronary artery bypass graft (CABG). DNC was administered to 90 patients and CBC to 212 patients. After propensity-score matching, 89 pairs were compared. The safety and efficacy were analyzed between the two groups. Results The DNC group had a similar mortality (3.4% vs. 5.6%, OR = 0.79, P = 0.720) and extracorporeal membrane oxygenation (ECMO) implantation rate (1.1% vs. 2.2%, OR = 0.75, P = 1.000) to the CBC group, a lower incidence of postoperative intra-aortic balloon pump (IABP) implantation (1.1% vs. 9.0%, OR = 0.54, P = 0.034) and a higher left ventricular ejection fraction (LVEF) at discharge (60 (56–64) % vs. 57 (51–62)%, P = 0.007). The estimated glomerular filtration rate (eGFR) in the DNC group was higher when the patient was transferred to the intensive care unit (79.4 (65.0-94.3) ml/min/1.73m2 vs. 77.2 (59.8–88.7) ml/min/1.73m2, P = 0.014), but no significant differences were identified after 24 h. The serum lactate values of the DNC group were significantly lower than those of the CBC group (0 h: 2.7 (2.0-3.2) vs. 3.2 (2.4–4.4), P = 0.001; 3 h: 3.2 (2.0-4.8) vs. 4.8 (2.8–6.6), P < 0.001; 6 h: 3.5 (2.2–5.4) vs. 5.8 (3.4–8.4), P < 0.001; 9 h: 3.4 (2.0–7.0) vs. 5.5 (2.9–8.3), P = 0.005). There were no differences between the two groups in respect of lactate levels at 12 h and thereafter. Postoperative creatinine kinase-MB concentrations were similar between the two groups. Conclusions Del-Nido cardioplegia is safe and effective in elderly patients undergoing CABG and/or valve surgery.

show abstract

Section: Discussionmentioning

confidence: 99%

Del-Nido cardioplegia in cardiac surgery for elderly patients: a propensity score-matched analysis

Qing

Luo

et al. 2023

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…advances in 3D echocardiography, and the use of moderate sedation) are constantly being improved. Hence, this method, rather than SAVR, is likely to be a more modifiable factor in the reduction of postoperative renal function impairment [16,21].…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury as the most important predictor of poor prognosis after interventional treatment for aortic stenosis

et al. 2022

View full text Add to dashboard Cite

Background: Aortic stenosis (AS) is the most common acquired valvular disease. There are two methods of interventional treatment: surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI). The choice between SAVR and TAVI depends on the assessment of individual perioperative risk and long-term treatment outcomes. It is essential to identify factors that may influence the outcomes of the treatment to minimize their negative effects. Aims:The study aimed to identify the most important risk factor which affects treatment outcomes in patients with AS undergoing SAVR/TAVI. Methods:This study reviewed retrospectively patients with AS who underwent SAVR or TAVI. The primary outcomes included incidences of major adverse cardiovascular events (MACE) defined as cardiovascular death, stroke, and hospitalization for cardiovascular issues assessed over a one-year follow-up period. An occurrence of postprocedural AKI (acute kidney injury) was identified as an independent predictor of MACE. Results:The study included 78 patients, with the same number of subjects in each group (SAVR/TAVI [n = 39]). Twenty-nine patients developed AKI. It was similar in both groups (SAVR [n = 15]; TAVR [n = 14]). In the SAVR group, 13 (33%) patients developed at least one MACE compared to 5 (13%) patients in the TAVI group. AKI and the type of procedure (SAVR) were shown to be significantly and independently associated with the development of MACE (P = 0.01 and P = 0.03, respectively) as shown in the Cox multivariable regression model. Conclusions:Our study demonstrated that AKI is the strongest predictor of major adverse cardiovascular events after using both methods of aortic valve replacement (SAVR/TAVI).

show abstract

“…Among clinical factors, acute kidney injury is especially of interest because for those who received heart surgery, post-operation acute kidney injury (AKI) is relatively common and is estimated to be as high as 42%, based on a varied de nition of cardiac surgery-associated AKI [11,12,13,14,15,16,17]. And there are several studies showing AKI has an effect on warfarin dosage.…”

Section: Introductionmentioning

confidence: 99%

Acute kidney injury interacts with VKORC1 genotype on initiative warfarin dose among heart surgery recipients: a real-world research

Liu

et al. 2023

Preprint

View full text Add to dashboard Cite

Patients who receive heart valve surgery need anticoagulation prophylaxis to reduce the risk of thrombosis. Warfarin often is a choice but its dosage varies due to gene and clinical factors. We aim to study, among them, if there is an interaction between acute kidney injury and two gene polymorphisms from this study. We extracted data of heart valve surgery recipients from the EHR system of a medical center. The primary outcome is about the average daily dose of warfarin, measured as an additive interaction parameter between acute kidney injury and warfarin-related gene polymorphisms. The confounders, including age, sex, BSA, comorbidities (i.e., AF, hypertension, CHF), serum albumin level, warfarin-relevant gene polymorphism (i.e., CYP2C9, VKORC1), prosthetic valve type (i.e., metal, bio), and warfarin history were controlled via a multivariate-linear regression model. We found a significant additive interaction between acute kidney injury and VKORC1 (-1.17, 95%CI -1.82 to -0.53, p=0.0004). This result suggests it is probable that there is an interaction between acute kidney injury and the genotype for the warfarin dose during the initial period of anticoagulation prophylaxis.

show abstract

Acute Kidney Injury after Heart Valve Surgery in Elderly Patients: any Risk Factors to Modify?

Cited by 11 publications

References 26 publications

Del-Nido cardioplegia in cardiac surgery for elderly patients: a propensity score-matched analysis

Del-Nido cardioplegia in cardiac surgery for elderly patients: a propensity score-matched analysis

Acute kidney injury as the most important predictor of poor prognosis after interventional treatment for aortic stenosis

Acute kidney injury interacts with VKORC1 genotype on initiative warfarin dose among heart surgery recipients: a real-world research

Contact Info

Product

Resources

About