Cardiac catheterization within 1 to 3 days of proximal aortic surgery is not associated with increased postoperative acute kidney injury

Abstract

Objective Cardiac catheterization shortly before coronary artery bypass grafting or valve surgery has been associated with increased postoperative acute kidney injury. The relationship between catheterization timing and acute kidney injury following proximal aortic surgery remains unknown. Methods Between August 2005 and February 2011, 285 consecutive patients underwent cardiac catheterization prior to elective proximal aortic surgery with cardiopulmonary bypass at a single institution. The association between timing of catheterization and postoperative acute kidney injury (defined as postoperative increase in serum creatinine ≥ 50% of baseline) was assessed using logistic regression analysis. Results Of 285 patients, 152 (53%) underwent catheterization on preoperative days 1-3 and 133 (47%) underwent catheterization on preoperative day 4 or before. Acute kidney injury occurred in 88 (31%) patients, three (1.1%) requiring dialysis. Acute kidney injury occurred in 37 (24%) patients catheterized on preoperative days 1-3, and 51 (38%) patients catheterized on preoperative day 4 or before. Catheterization on preoperative day 1-3 was not associated with an increased risk of acute kidney injury relative to catheterization on preoperative day 4 or before (unadjusted odds ratio 0.52, 95% confidence interval 0.31–0.86, P = 0.01; adjusted odds ratio 0.35, 95% confidence interval 0.17–0.73, P = 0.005). Conclusions Cardiac catheterization within one to three days of elective proximal aortic surgery appears safe and should be considered acceptable practice for patients at low-risk of acute kidney injury.

Acute Kidney Injury Following Surgical Aortic Valve Replacement

“…We did not find that a shorter preoperative cardiac catheterization interval (≤5 days) is associated with a higher AKI incidence in isolated SAVR. These results reiterate the conclusions of other research groups who found that delaying isolated valve surgeries after coronary angiography is not justified in most patients . Whenever AKI occurs, efforts should focus on providing an early diagnosis and treatment plan, especially that duration of AKI has been shown to impact long‐term survival following cardiac surgery .…”

“…These results reiterate the conclusions of other research groups who found that delaying isolated valve surgeries after coronary angiography is not justified in most patients. [30][31][32] Whenever AKI occurs, efforts should focus on providing an early diagnosis and treatment plan, especially that duration of AKI has been shown to impact long-term survival following cardiac surgery. 10 Some major therapeutic principles are: 1) maintenance of systemic hemodynamics through the detection and treatment of volume depletion, improvement of cardiac contractility using inotropes, and reduction of afterload with vasodilators, 2) avoidance of nephrotoxic drugs and agents, 3) use of diuretics such as furosemide 29,30 to increase urine output, 4) mesenchymal stem cells (MSC), a novel and promising therapeutic option whose benefits are related to the release by MSCs of factors promoting tubular cell proliferation, [33][34][35] and if all fails to improve renal function, 5) early renal replacement therapy can be attempted, as it has shown promising results in some series.…”

The effect of the time interval between coronary angiography and on-pump cardiac surgery on risk of postoperative acute kidney injury: a meta-analysis

“…The lack of association between CAG on preoperative days 1 through 3 and increased risk of AKI in the one study of the CPB/DHCA subgroup seems controversial, given that the pooled effect of the CPB subgroup did show a significant association (adjusted OR, 0.35; 95% CI, 0.17-0.73; P  = 0.005) [10]. However, the CPB/DHCA subgroup had a much more higher incidence of AKI, about 31% if defined by the RIFLE criteria, while, the highest incidence of the other studies was only 18% if defined by the RIFLE criteria, or 32% if defined by the AKI network criteria [9].…”

Results with an algorithmic approach to hybrid repair of the aortic arch

“…The Duke Thoracic Aortic Surgery Database is a prospectively maintained electronic clinical registry of all patients who have undergone thoracic aortic surgery at Duke University Medical Center (Durham, NC) since 2005. 21, 22 A query of the database identified 387 consecutive TEVAR operations performed between March 2005 and January 2012; of these, 87 (22%) were hybrid arch repairs and form the basis of this report. General criteria regarding patient selection for hybrid arch repair are listed in Figure 1.…”