Correlation of Preoperative Renal Insufficiency With Mortality and Morbidity After Aortic Valve Replacement

Abstract

Preoperative end-stage renal disease carries a high mortality and morbidity risk after aortic valve replacement (AVR), but the effect of renal insufficiency remains to be clarified. Through propensity score analysis, we compared the preoperative demographics, perioperative profiles, and outcomes between patients with and without renal insufficiency.From August 2005 to November 2014, 770 adult patients underwent AVR in a single institution. Patients were classified according to their estimated glomerular infiltration rate (eGFR) as renal insufficiency (eGFR: 30–89 mL/min/1.73 m2) or normal (eGFR, ≥90 mL/min/1.73 m2). Propensity scoring was performed with a 1:1 ratio, resulting in a matched cohort of 88 patients per group.Demographics, comorbidities, and surgical procedures were well balanced between the 2 groups, except for diabetes mellitus and eGFR. Patients with renal insufficiency had higher in-hospital mortality (19.3% versus 3.4%, P < .001), a greater need for postoperative hemodialysis (14.8% versus 3.1%, P = .009), and prolonged intubation times (>72 hour; 25% versus 9.1%, P = .008), intensive care unit stays (8.9 ± 9.9 versus 4.9 ± 7.5 days, P = .046), and hospital stays (35.3 ± 31.7 versus 24.1 ± 20.3 days, P = .008), compared with those with normal renal function. Multivariate analysis confirmed that preoperative renal insufficiency was an in-hospital mortality predictor (odds ratio, 2.33; 95% confidence interval, 1.343–4.043; P = .003), as were prolonged cardiopulmonary bypass time, intraaortic balloon pump support, and postoperative hemodialysis. The 1-year survival significantly differed between the 2 groups including (normal 87.5% versus renal insufficiency 67.9%, P < .001) or excluding in-hospital mortality (normal 90.7% versus renal insufficiency 82.1%, P = .05).Patients with preoperative renal insufficiency who underwent AVR had higher in-hospital mortality rates and increased morbidities, especially those associated with hemodynamic instabilities requiring intraaortic balloon pump support or hemodialysis. Earlier surgical intervention for severe aortic valve disease should be considered in patients who show deteriorating renal function during follow-up.

Sutureless aortic bioprosthesis replacement in elderly Asian patients with aortic stenosis: Experience in a single institution

“…reported that the shorter procedure time in SU-AVR was associated with a lower rate of postoperative complications, a shorter intubation time, a shorter ICU stay, and reduced hospital costs compared to conventional AVR [17] . In a previous study reported from this institute [18] , the mean cross-clamp and CPB times were 123 ± 53.1 min and 157 ± 78.6 min respectively, and both longer then the data observed in the present study. Besides, it also revealed more extended ICU stay (4.9 ± 7.5 days) and hospital stay (24.1 ± 20.3 days) compared to the present study.…”

Lactate level during cardiopulmonary bypass as a predictor of postoperative outcomes in adult patients undergoing cardiac surgery

“…Preoperative renal function also independently contributes to ICU-free survival days. A previous study suggested that preoperative serum creatinine was a predictor for postoperative renal complications and in-hospital mortality in patient undergoing cardiac surgery [ 6 , 21 ]. In addition, it has also suggested that CPB duration would prolong in patients with preoperative renal insufficiency [ 6 , 21 ].…”

Pre- and Postoperative Predictors of Long-Term Prognosis After Aortic Valve Replacement for Severe Chronic Aortic Regurgitation

“…31 Renal insufficiency is also related to a low preoperative EF. Moreover, DM is a well-known risk factor for coronary artery disease and other macrovascular events, 32,33 and the relationship between renal function and DM is strong.…”