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Hachiro K, Kinoshita T, Suzuki T, Asai T. Total arch replacement in patients with chronic kidney disease. J Card Surg 2021; 36:475-482. [PMID: 33259107 DOI: 10.1111/jocs.15219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/24/2020] [Accepted: 11/16/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND We investigated the effect of preoperative renal dysfunction on postoperative outcomes in patients undergoing elective isolated total arch replacement (TAR) with mild hypothermic lower body circulatory arrest with antegrade selective cerebral perfusion (SCP). METHODS One hundred and forty-four patients who had undergone elective isolated TAR between January 2002 and December 2019 were retrospectively analyzed. Patients were divided into two groups according to whether their preoperative estimated glomerular filtration rate (eGFR) was lower than or higher than 60 ml/min/1.73 m2 . We compared perioperative data and mid-term outcomes after adjusting for patients' baseline characteristics using weighted logistic regression analysis and inverse probability of treatment weighting. RESULTS More patients underwent postoperative stroke in the chronic kidney disease group compared with the normal group (2.8% vs. 0%, respectively; p = .049). Overall 30-day mortality and hospital mortality were 0% in both groups, and there was no significant difference in overall survival between the two groups (log-rank test, p = .129). Multivariate Cox proportional hazard analysis showed that eGFR < 60 ml/min/1.73 m2 was not an independent predictor (hazard ratio: 1.636, 95% confidence interval 0.829-3.231; p = .156). CONCLUSIONS Preoperative eGFR <60 ml/min/1.73 m2 was not associated with worse outcomes after elective isolated TAR with mild hypothermic lower body circulatory arrest with antegrade SCP.
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Affiliation(s)
- Kohei Hachiro
- Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Takeshi Kinoshita
- Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tomoaki Suzuki
- Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tohru Asai
- Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
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Ishida K, Uchida M, Utada K, Yamashita A, Yamashita S, Fukuda S, Matsumoto M, Sakabe T. Cerebrovascular CO 2 reactivity during isoflurane-nitrous oxide anesthesia in patients with chronic renal failure. J Anesth 2017; 32:15-22. [PMID: 29103148 DOI: 10.1007/s00540-017-2422-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE We assessed the cerebrovascular CO2 reactivity (CO2R) in chronic renal failure (CRF) patients without diabetes mellitus (DM), uncontrolled hypertension, peripheral vascular disease, or neurological disease under isoflurane-nitrous oxide anesthesia. METHODS Forty-nine patients undergoing surgery, including 36 CRF patients (30 receiving dialysis and six pre-dialysis patients) and 13 patients without CRF (controls). Middle cerebral artery flow velocity (VMCA) was measured by transcranial Doppler ultrasonography at an end-tidal CO2 of 35 to 45 mmHg. CO2R was calculated as an absolute value (change in VMCA per mmHg PaCO2) and a relative value (absolute CO2R/baseline VMCA × 100). Factors associated with CO2R were evaluated simultaneously. RESULTS Despite no significant differences in the absolute and relative values of CO2R between the CRF (mean 2.5 cm/s/mmHg; median 5.0%/mmHg) and control (2.4 cm/s/mmHg; 5.0%/mmHg) groups, blood urea nitrogen (BUN) concentrations in the CRF group correlated inversely with both absolute and relative CO2R. BUN concentration was higher (mean 72 versus 53 mg/dl, p = 0.006) and relative CO2R was lower (mean 2.6 versus 5.7%/mmHg, p = 0.011) in patients with pre-dialysis CRF (n = 6) versus CRF patients receiving dialysis (n = 30). CONCLUSIONS CO2R in CRF patients was not significantly different from that in controls. However, in CRF patients with high BUN concentrations, CO2R might be impaired, leading to reduced cerebrovascular reserve capacity. Because DM is a major cause of CRF and we excluded DM patients, our results might not be applicable to patients with DM-induced CRF.
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Affiliation(s)
- Kazuyoshi Ishida
- Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Masato Uchida
- Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Kohji Utada
- Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Atsuo Yamashita
- Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Satoshi Yamashita
- Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Shiro Fukuda
- Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Mishiya Matsumoto
- Department of Anesthesiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Takefumi Sakabe
- Department of Anesthesiology, Yamaguchi Rosai Hospital, 1315-4 Onoda, Sanyoonoda, Yamaguchi, 756-0095, Japan
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Borji R, Ahmadi SH, Barkhordari K, Meysami AP, Karimi AA, Mortazavi SH, Dadlani P, Ayatollah Zadeh Esfahani F, Khatami SMR. Effect of Prophylactic Dialysis on Morbidity and Mortality in Non-Dialysis-Dependent Patients after Coronary Artery Bypass Grafting: A Pilot Study. Nephron Clin Pract 2017; 136:226-232. [PMID: 28433995 DOI: 10.1159/000470854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 03/10/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Coronary artery bypass grafting (CABG) is associated with an increased risk of morbidity and mortality in patients with pre-existing renal dysfunction. Numerous measures have been implemented to overcome this problem; however, no improvement in outcomes has been achieved. This study was aimed at investigating the effects of prophylactic dialysis on mortality and morbidity in these patients. METHODS This randomized-controlled clinical trial enrolled 88 non-dialysis-dependent patients with chronic kidney disease awaiting CABG surgery. Thirty-nine randomly selected patients received dialysis 3 times prior to surgery, and 49 patients formed the control group. Kaplan-Meier analysis and Cox proportional-hazards models were used to identify factors associated with survival. RESULTS There was no significant difference in the development of morbidities between the groups (p = 0.413). A significant difference was evident in the average survival time (p = 0.037). Cox proportional-hazards models determined that the hazard ratio of death after surgery was 10.854-fold greater in non-dialysis patients than in patients who received dialysis (hazard ratio = 2). CONCLUSION Prophylactic dialysis prior to CABG decreases mortality, but does not affect morbidity, in patients with renal insufficiency.
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Affiliation(s)
- Roghayeh Borji
- Internal Medicine Department, Imam Khomeini Hospital, Tehran, Iran
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Phan K, Zhao DF, Zhou JJ, Karagaratnam A, Phan S, Yan TD. Bioprosthetic versus mechanical prostheses for valve replacement in end-stage renal disease patients: systematic review and meta-analysis. J Thorac Dis 2016; 8:769-77. [PMID: 27162649 DOI: 10.21037/jtd.2016.02.74] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with end-stage renal disease (ESRD) indicated for dialysis are increasingly requiring cardiac valve surgery. The choice of bioprosthetic or mechanic valve prosthesis for such patients requires careful risk assessment. A systematic review and meta-analysis was performed to assess current evidence available. METHODS A comprehensive search from six electronic databases was performed from their inception to February 2015. Results from patients with ESRD undergoing cardiac surgery for bioprosthetic or mechanical valve replacement were identified. RESULTS Sixteen studies with 8,483 patients with ESRD undergoing cardiac valve replacement surgery were included. No evidence of publication bias was detected. Prior angioplasty by percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery was significantly higher in the bioprosthetic group compared to the mechanical group (16.0% vs. 12.0%, P=0.04); all other preoperative baseline patient characteristics were similar. There was no significant difference in 30-day mortality or all-cause mortality between the two comparisons. Compared with the mechanical group, the frequency of bleeding (5.2% vs. 6.4%, P=0.04) and risk of thromboembolism (2.7% vs. 12.8%, P=0.02) were significantly lower in the bioprosthetic group. There were similar rates of reoperation and valve endocarditis. CONCLUSIONS The present study demonstrated that patients with ESRD undergoing bioprosthetic or mechanical valve replacement had similar mid-long term survival. The bioprosthetic group had lower rates of bleeding and thromboembolism. Further studies are required to differentiate the impact of valve location. The presented results may be applicable for ESRD patients requiring prosthetic valve replacement.
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Affiliation(s)
- Kevin Phan
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 The University of Sydney, Sydney, Australia
| | - Dong Fang Zhao
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 The University of Sydney, Sydney, Australia
| | - Jessie J Zhou
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 The University of Sydney, Sydney, Australia
| | - Aran Karagaratnam
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 The University of Sydney, Sydney, Australia
| | - Steven Phan
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 The University of Sydney, Sydney, Australia
| | - Tristan D Yan
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 The University of Sydney, Sydney, Australia
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Fernando M, Paterson HS, Byth K, Robinson BM, Wolfenden H, Gracey D, Harris D. Outcomes of cardiac surgery in chronic kidney disease. J Thorac Cardiovasc Surg 2014; 148:2167-73. [DOI: 10.1016/j.jtcvs.2013.12.064] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/24/2013] [Accepted: 12/10/2013] [Indexed: 11/25/2022]
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Goupil R, Bonnardeaux A, Boucher A, Collette S, Ouimet D, Sénécal L, Tran D, Vallée M. Difficulty of patient selection in a combined heart-kidney transplant: a case report. EXP CLIN TRANSPLANT 2014; 12:273-6. [PMID: 24568727 DOI: 10.6002/ect.2013.0038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Combined heart-kidney transplant has become an alternative for heart transplant candidates with significant chronic kidney disease. However, it is not clear which patients will benefit most from such intervention, and in whom cardiac transplant alone will be sufficient to restore adequate renal function. We report the case of a man with ischemic cardiomyopathy and chronic kidney disease who was wait-listed for heart-kidney transplant after acute decompensated heart failure and renal failure requiring hemodialysis. Because of unexpected circumstances, the kidney transplant was cancelled, and only a heart transplant was performed. Nonetheless, the kidney function rapidly improved beyond the levels before hospitalization and remains stable months after transplant. This case illustrates the difficulties in assessing the reversibility of kidney damage in the context of heart failure requiring transplant. This issue is primordial to improve selection of patients who will benefit most from combined heart-kidney transplant in a context of scarce organ allocation resources.
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Affiliation(s)
- Rémi Goupil
- From the Nephrology and Kidney Transplantation Department, Hôpital Maisonneuve-Rosemont, Québec, Canada
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Cherng YG, Liao CC, Chen TH, Xiao D, Wu CH, Chen TL. Are non-cardiac surgeries safe for dialysis patients? - A population-based retrospective cohort study. PLoS One 2013; 8:e58942. [PMID: 23516581 PMCID: PMC3597566 DOI: 10.1371/journal.pone.0058942] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 02/11/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND End-stage renal disease represents a risk complex that complicates surgical results. The surgical outcomes of dialysis patients have been studied in specific fields, but the global features of postoperative adverse outcomes in dialysis patients receiving non-cardiac surgeries have not been examined. METHODS Taiwan's National Health Insurance Research Database was used to study 8,937 patients under regular dialysis with 8,937 propensity-score matched-pair controls receiving non-cardiac surgery between 2004 and 2007. We investigated the influence of hemodialysis and peritoneal dialysis, effects of hypertension and diabetes, and impact of additional comorbidities on postoperative adverse outcomes. RESULTS Postoperative mortality in dialysis patients was higher than in controls (odds ratio [OR] 3.33, 95% confidence interval [CI] 2.56 to 4.33) when receiving non-cardiac surgeries. Complications such as acute myocardial infarction, pneumonia, bleeding, and septicemia were significantly increased. Postoperative mortality was significantly increased among peritoneal dialysis patients (OR 2.71, 95% CI 1.70 to 4.31) and hemodialysis patients (OR 3.42, 95% CI 2.62 to 4.47) than in controls. Dialysis patients with both hypertension and diabetes had the highest risk of postoperative complications; these risks increased with number of preoperative medical conditions. Patients under dialysis also showed significantly increased length of hospitalization, more ICU stays and higher medical expenditures. CONCLUSION Surgical patients under dialysis encountered significantly higher postoperative complications and mortality than controls when receiving non-cardiac surgeries. Different dialysis techniques, pre-existing hypertension/diabetes, and various comorbidities had complication-specific impacts on surgical adverse outcomes. These findings can help surgical teams provide better risk assessment and postoperative care for dialysis patients.
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Affiliation(s)
- Yih-Giun Cherng
- Department of Anesthesiology, Shuang Ho Hospital, affiliated with Taipei Medical University, New Taipei City, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Tso-Hsiao Chen
- Department of Nephrology, Wan Fang Medical Center, affiliated with Department of Internal Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Duan Xiao
- Department of Coloproctology, the Second People’s Hospital of Shi-Fang City, Shi-Fang City, Sichuan Province, People Republic of China
| | - Chih-Hsiung Wu
- Department of Surgery, Shuang Ho Hospital, affiliated with Taipei Medical University, New Taipei City, Taiwan
| | - Ta-Liang Chen
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- * E-mail:
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Thourani VH, Sarin EL, Kilgo PD, Lattouf OM, Puskas JD, Chen EP, Guyton RA. Short- and long-term outcomes in patients undergoing valve surgery with end-stage renal failure receiving chronic hemodialysis. J Thorac Cardiovasc Surg 2012; 144:117-23. [DOI: 10.1016/j.jtcvs.2011.07.057] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 07/04/2011] [Accepted: 07/26/2011] [Indexed: 10/17/2022]
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Shavit L, Tauber R, Lifschitz M, Bitran D, Slotki I, Fink D. Influence of minimal changes in preoperative renal function on outcomes of cardiac surgery. Kidney Blood Press Res 2012; 35:400-6. [PMID: 22555290 DOI: 10.1159/000335950] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 12/15/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Cardiovascular morbidity and mortality are high in patients with chronic kidney disease. We evaluated the influence of small differences in preoperative kidney function on mortality and complications following cardiac surgery. METHODS This is an observational study that included adult patients undergoing cardiac surgery. Preoperative estimated glomerular filtration rate (eGFR) was estimated by the 4-component Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations based on preoperative creatinine levels. For analysis, patients were divided into groups according to their preoperative creatinine (0.2 mg/dl increments) and eGFR levels (15-30 ml/min/1.73 m(2) decrements). RESULTS Data on 5,340 patients were analyzed. A significant increase in postoperative mortality was demonstrated with preoperative creatinine at high-normal versus low-normal values (OR 1.7, 95% CI: 1-2.5; p = 0.02). For preoperative creatinine >1.2 mg/dl, adjusted OR for in-hospital mortality increased stepwise with every 0.2-mg/dl increment of creatinine. In addition, a statistically significant increment of mortality was detected with every 15-ml/min/1.73 m(2) decrement in preoperative eGFR. CONCLUSIONS Minimal changes of preoperative kidney function are associated with a substantial increase in the risk of mortality and morbidity following cardiac surgery. Even within the 'normal' range, minimal increases in serum creatinine levels are associated with increased risk of adverse events postoperatively.
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Affiliation(s)
- Linda Shavit
- Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel. lshavit @ szmc.org.il
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Sajja LR, Mannam G, Chakravarthi RM, Guttikonda J, Sompalli S, Bloomstone J. Impact of preoperative renal dysfunction on outcomes of off-pump coronary artery bypass grafting. Ann Thorac Surg 2011; 92:2161-7. [PMID: 21962259 DOI: 10.1016/j.athoracsur.2011.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 04/29/2011] [Accepted: 05/03/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND This study assessed whether preoperative renal insufficiency predisposes patients undergoing off-pump coronary artery revascularization to postoperative dialysis. METHODS From August 2004 through June 2009, 2,275 patients undergoing off-pump coronary artery bypass were categorized into five groups (stages) by glomerular filtration rate (GFR). Of these, 1,855 patients had renal insufficiency: stage 2: 1,406; stage 3: 428; stage 4: 21, and 414 had normal renal function, stage 1. Excluded were 6 patients with end-stage renal disease (stage 5). Preoperative variables and postoperative outcomes were compared among groups. RESULTS Preoperative patient characteristics were similar; however, patients with normal renal function were younger (p = 0.001). Serum creatinine rose significantly above baseline on the first postoperative day in the renal insufficiency groups (p = 0.001). The GFR groups had similar inotrope use, reexploration rate, duration of postoperative mechanical ventilation, postoperative stroke, wound infection, and mortality rate. Stage 4 patients had a higher incidence of postoperative myocardial infarction (p = 0.002). Stage 3 and 4 patients had an increased need for postoperative dialysis vs stage 1 patients (p = 0.002). CONCLUSIONS Nonparametric contingency analysis showed patients with low preoperative GFR (stage 3 and 4, p < 0.0001) and a history of smoking (p = 0.04) were at increased risk for postoperative dialysis. Patients who required postoperative inotropic support tended toward requiring postoperative dialysis (p = 0.06). Low preoperative ejection fraction (p = 0.83), class III or IV angina (p = 0.069), and postoperative blood transfusions were not associated with the need for postoperative dialysis in patients undergoing off-pump revascularization.
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Affiliation(s)
- Lokeswara Rao Sajja
- Division of Cardiothoracic Surgery, Star Hospitals, Banjara Hills, Hyderabad, India.
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11
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Caynak B, Bayramoğlu Z, Onan B, Onan IS, Sağbaş E, Sanisoğlu I, Akpınar B. The impact of non-dialysis-dependent renal dysfunction on outcome following cardiac surgery. Heart Surg Forum 2011; 14:E214-20. [PMID: 21859638 DOI: 10.1532/hsf98.20101161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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 dialysis-dependent. METHODS Eighty-two patients who presented with non-dialysis-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.
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Affiliation(s)
- Barış Caynak
- Department of Cardiovascular Surgery, Florence Nightingale Hospital, Abide-i Hurriyet Caddesi No: 164, Sisli, Istanbul, Turkey.
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Long-Term Survival for Patients With Preoperative Renal Failure Undergoing Bioprosthetic or Mechanical Valve Replacement. Ann Thorac Surg 2011; 91:1127-34. [PMID: 21353200 DOI: 10.1016/j.athoracsur.2010.12.056] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 12/24/2010] [Accepted: 12/30/2010] [Indexed: 11/22/2022]
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Chikwe J, Castillo JG, Rahmanian PB, Akujuo A, Adams DH, Filsoufi F. The Impact of Moderate–to–End-Stage Renal Failure on Outcomes After Coronary Artery Bypass Graft Surgery. J Cardiothorac Vasc Anesth 2010; 24:574-9. [DOI: 10.1053/j.jvca.2009.10.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Indexed: 11/11/2022]
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14
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The Role of Elective Perioperative Dialysis in Nondialysis Renal Failure Patients. Ann Thorac Surg 2009; 87:1085-8; discussion 1088-9. [DOI: 10.1016/j.athoracsur.2008.12.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 12/25/2008] [Accepted: 12/26/2008] [Indexed: 11/21/2022]
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15
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Filsoufi F, Chikwe J, Castillo JG, Rahmanian PB, Vassalotti J, Adams DH. Prosthesis type has minimal impact on survival after valve surgery in patients with moderate to end-stage renal failure. Nephrol Dial Transplant 2008; 23:3613-21. [PMID: 18606623 DOI: 10.1093/ndt/gfn337] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Farzan Filsoufi
- Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA.
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16
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Maslow AD, Chaudrey A, Bert A, Schwartz C, Singh A. Perioperative Renal Outcome in Cardiac Surgical Patients With Preoperative Renal Dysfunction: Aprotinin Versus Epsilon Aminocaproic Acid. J Cardiothorac Vasc Anesth 2008; 22:6-15. [DOI: 10.1053/j.jvca.2007.07.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Indexed: 11/11/2022]
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Ledoux D, Monchi M, Chapelle JP, Damas P. Cystatin C blood level as a risk factor for death after heart surgery. Eur Heart J 2007; 28:1848-53. [PMID: 17617637 DOI: 10.1093/eurheartj/ehm270] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Pre-operative renal dysfunction is a known risk factor for mortality and morbidity after heart surgery. Despite limited accuracy, serum creatinine is widely used to estimate glomerular filtration rate (GFR). Cystatin C is more accurate for assessing GFR. The aim of the present study was to assess associations between GFR estimated from serum cystatin C levels before heart surgery and hospital mortality, hospital morbidity, and 1 year mortality. METHODS AND RESULTS In a prospective single-centre observational study, clinical risk factors for morbidity and mortality were recorded and serum creatinine and cystatin C levels were measured in patients admitted for heart surgery. Hospital mortality and morbidity and 1 year mortality were recorded. Over an 8 month period, 499 patients were screened, among whom 376 (74.5%) were included in the study. Hospital mortality was 5.6% (21 patients) and 1 year mortality was 10.2%. Hospital morbidity, defined by a length of stay above the 75th percentile, was 22.1% (83 patients). In the multivariable analysis, GFR estimated from serum cystatin C, but not GFR estimated from serum creatinine, was an independent risk factor for hospital morbidity/mortality (odds ratio per 10 mL/min of GFR decrease, 1.20 (1.07-1.34), P = 0.001) and for 1 year mortality (hazards ratio per 10 mL/min of GFR decrease, 1.26 (1.09-1.46), P = 0.002). CONCLUSION Pre-operative GFR estimation from serum cystatin C may provide a better risk assessment than pre-operative GFR estimation from serum creatinine in patients scheduled for heart surgery.
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Affiliation(s)
- Didier Ledoux
- Intensive Care Unit, Liège University Hospital, Sart Tilman Bat B35, B-4000 Liège, Belgium.
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Casati V, Barbato L, D'Angelo A, Masotti C, Nocera G, Grasso MA, Porta A, Guerra F. Complex cardiac surgery in Jehovah's Witnesses with chronic renal failure. J Cardiothorac Vasc Anesth 2007; 22:453-4. [PMID: 18503941 DOI: 10.1053/j.jvca.2007.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Indexed: 11/11/2022]
Affiliation(s)
- Valter Casati
- Division of Cardiovascular Anesthesia and Intensive Care, Policlinico di Monza, Monza, Italy.
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Chan V, Jamieson WRE, Fleisher AG, Denmark D, Chan F, Germann E. Valve replacement surgery in end-stage renal failure: mechanical prostheses versus bioprostheses. Ann Thorac Surg 2006; 81:857-62. [PMID: 16488684 DOI: 10.1016/j.athoracsur.2005.09.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Revised: 08/30/2005] [Accepted: 09/06/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND The 1998 American College of Cardiology/American Heart Association Guidelines recommend mechanical prostheses for valve replacement in patients with end-stage renal disease requiring dialysis. The aim of the study is to evaluate the combined experience at two academic centers. METHODS Sixty-nine valve replacements (aortic 40; mitral 22; multiple 7; 47 bioprostheses, 22 mechanical prostheses) were performed. Total follow-up was 128.7 patient-years (bioprostheses, 68.4; mechanical prostheses, 60.4). RESULTS Patient populations were homogeneous, except for age (bioprostheses greater than mechanical prostheses, p = 0.012), previous myocardial infarction (bioprostheses greater than mechanical prostheses, p = 0.040), and concomitant CABG (bioprostheses greater than mechanical prostheses, p = 0.019). A survival advantage was observed in favor of mechanical prostheses (p = 0.0299) at 5 years. Freedom from valve-related complications at 5 years was calculated for thromboembolism plus thrombosis plus hemorrhage (bioprostheses, 93.0% +/- 3.9%; mechanical prostheses, 76.4% +/- 12.7%), thromboembolism excluding thrombosis (bioprostheses, 93.0% +/- 3.9%; mechanical prostheses, 88.9% +/- 10.5%), and hemorrhage (bioprostheses, 100%; mechanical prostheses, 95.2% +/- 4.7%). One case of structural valve deterioration occurred in the bioprostheses group at 95 months after surgery. Five-year freedom from all valve-related complications was 82.8% +/- 8.1% for bioprostheses and 76.4% +/- 12.7% for mechanical prostheses. CONCLUSIONS Overall survival was poor. Differences between populations were related to age at operation and coronary artery disease. Structural valve deterioration was not accentuated with bioprostheses. Considering lack of homogeneity between prostheses groups there was no superiority of mechanical prostheses over bioprostheses in terms of freedom from composites of complications. Bioprostheses should be considered in the management of valvular disease in end-state renal disease patients.
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Affiliation(s)
- Vincent Chan
- University of British Columbia, Vancouver, British Columbia, Canada
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Nakasuji M, Nishi S, Nakasuji K, Hamaoka N, Ikeshita K, Asada A. Early continuous venovenous hemodialysis in dialysis-dependent patients after cardiac surgery: safety and efficacy. J Cardiothorac Vasc Anesth 2006; 21:379-83. [PMID: 17544890 DOI: 10.1053/j.jvca.2006.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The present study assessed the safety and efficacy of continuous venovenous hemodialysis (CVVHD) early after cardiac surgery. DESIGN Retrospective database and medical record review. SETTING University teaching hospital. PARTICIPANTS Forty-five dialysis-dependent patients who underwent cardiac surgery with cardiopulmonary bypass. INTERVENTIONS CVVHD was begun postoperatively after confirmation of hemostasis, irrespective of circulatory status. In the last 5 patients, the ratio of extravascular lung water (EVLW) to intrathoracic blood volume (ITBV) was measured using a single-indicator thermodilution catheter and compared with patients of normal renal function undergoing cardiac surgery. MEASUREMENTS AND MAIN RESULTS CVVHD was started at 4 hours after ICU admission. The maximum decrease in blood pressure within 60 minutes after initiation of CVVHD was 11 +/- 9 mmHg in the unstable hemodynamics group (defined as patients who required continuous intravenous adrenaline or intra-aortic balloon pump on admission to the ICU [n = 15]) and 7 +/- 8 mmHg in the stable hemodynamics group (n = 30, not significant). Circulatory status and oxygenation improved significantly 12 hours after CVVHD initiation in the unstable hemodynamics group. Blood volume from the chest tube did not increase after CVVHD. Early mortality (2.2%) was lower than that reported previously. The EVLW/ITBV ratio after ICU admission in dialysis-dependent patients was significantly higher than in patients with normal renal function. CONCLUSIONS Early CVVHD after cardiac surgery in dialysis-dependent patients was safe and effective. There was no associated increased postoperative bleeding or hemodynamic instability. Fluid removal improved respiratory status, particularly in patients requiring circulatory assistance, and overall early morality rates were lower that those previously published.
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Affiliation(s)
- Masato Nakasuji
- Department of Anesthesiology and Intensive Care Medicine, Osaka City University Medical School, Osaka, Japan.
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Kawahito K, Adachi H, Murata SI, Yamaguchi A, Ino T. Impact of concomitant cardiac procedure on coronary artery surgery in hemodialysis-dependent patients. Gen Thorac Cardiovasc Surg 2006; 54:142-8. [PMID: 16642919 DOI: 10.1007/bf02662468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Coronary artery bypass grafting (CABG) in hemodialysis-dependent patients is associated with high mortality and morbidity rates. This retrospective study was undertaken to identify the risk factors for in-hospital mortality for hemodialysis-dependent patients. METHODS Subjects included 87 consecutive hemodialysis-dependent patients (81 men and 6 women), aged 47-82 years (mean age, 65 years), who underwent CABG. Operative procedures included CABG alone (n=77) and CABG with valve replacement, repair, or the Dor procedure (n=10). Thirty-one perioperative risk factors were subjected to univariate and multivariate analyses to identify the risk factors for hospital death. RESULTS The overall in-hospital mortality rate, including operative death, was 14.9% (13/87). Univariate analysis showed the following 7 risk factors to be statistically significant predictors of hospital death: age > or = 70 years, a concomitant cardiac procedure, left ventricular ejection fraction <30%, left ventricular end-systolic volume index >70 ml/m2, a left main lesion, emergency/urgent surgery, and anemia (hemoglobin <10 mg/dl) (p<0.05 for each predictor). Multivariate logistic regression analysis confirmed that a concomitant cardiac procedure (chi-squared = 17.080, p=0.013) and age > or = 70 years (chi-squared = 9.112, p=0.019) are statistically significant independent risk factors for hospital death. CONCLUSION A concomitant cardiac procedure and age > or = 70 years were identified as significant independent risk factors for hospital mortality after CABG for hemodialysis-dependent patients. These preoperative risk factors may help in predicting operative risks and improving clinical outcomes in hemodialysis-dependent patients undergoing CABG.
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Affiliation(s)
- Koji Kawahito
- Department of Cardiovascular Surgery, Omiya Medical Center, Jichi Medical School, Saitama, Japan
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Odim J, Wheat J, Laks H, Kobashigawa J, Gjertson D, Osugi A, Mukherjee K, Saleh S. Peri-operative Renal Function and Outcome after Orthotopic Heart Transplantation. J Heart Lung Transplant 2006; 25:162-6. [PMID: 16446215 DOI: 10.1016/j.healun.2005.07.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2004] [Revised: 07/11/2005] [Accepted: 07/20/2005] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Renal insufficiency is an established risk factor in patients undergoing cardiovascular surgery. We sought to evaluate the relationship between renal function and outcomes after orthotopic heart transplantation (OHT). METHODS We conducted a retrospective review of 622 adults who underwent 628 consecutive OHTs between 1994 and 2001 at our institution. The recipients were divided into either normal (Group 1) or impaired (Group 2) pre-operative renal function. Impaired renal function was defined as creatinine clearance (CrCl) < 40 ml/min (Cockroft-Gault formula). Meanwhile, patients in Group 1 (normal) were defined by CrCl > or = 40 ml/min. The primary end points of the study were early and late mortality. The secondary end point included post-operative renal failure defined by the requirement of dialysis or renal allograft in the early post-operative period. The Kaplan-Meier method was used to determine actuarial survival. RESULTS Early mortality was 7% (38/531) in Group 1 and 17% (16/96) in Group 2 (p = 0.002). Similarly, the death rate per 100 patient-years was 4.8 and 8.1 for the groups, respectively (p = 0.03). Nine percent of patients in Group 1 required post-operative dialysis (49/531), whereas 32% of recipients in Group 2 required this intervention (31/96) (p < 0.001). Early mortality was 41% for patients requiring post-operative dialysis and 3% for those not requiring such intervention (p < 0.001). Early mortality after post-operative dialysis was 41% (20/49) in Group 1 and 42% (13/31) in Group 2 (p = 0.2). CONCLUSIONS CrCl < 40 ml/min is a useful marker for increased post-operative renal failure and mortality. Recipients who require post-operative dialysis have greatly increased mortality regardless of pre-operative CrCl. Dialysis in patients after heart transplantation carries a prohibitive risk. Dialysis as a bridge to renal transplantation may reduce this high mortality rate.
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Affiliation(s)
- Jonah Odim
- Department of Surgery, Medicine and Pathology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1741, USA.
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Zimmet AD, Almeida A, Goldstein J, Shardey GC, Pick AW, Lowe CE, Jolley DJ, Smith JA. The Outcome of Cardiac Surgery in Dialysis-Dependent Patients. Heart Lung Circ 2005; 14:187-90. [PMID: 16352275 DOI: 10.1016/j.hlc.2005.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2004] [Revised: 01/05/2005] [Accepted: 02/18/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patients on dialysis for end-stage renal failure (ESRF) are undergoing cardiac surgery with increasing frequency. Furthermore, ESRF is known to be an important risk factor for complications of cardiac operations performed with cardiopulmonary bypass. AIMS To evaluate the outcome of dialysis-dependent patients undergoing cardiac surgery at one institution. METHODS A retrospective analysis was performed on consecutive patients with ESRF dependent upon maintenance haemodialysis or peritoneal dialysis who underwent cardiac surgery from January 1998 to August 2002. RESULTS Thirty-eight patients on dialysis underwent cardiac surgery during this time period (1.5% of total cases). The most common cause for ESRF was diabetic nephropathy (n = 12). Operations performed included isolated coronary artery bypass grafting (CABG, n = 22), CABG and valve surgery (n = 8), and valve surgery alone (n = 6). When allowing for age, sex, surgeon and operative category, the odds ratio for mortality risk of dialysis patients, compared with all others, was 4.9 (95% confidence interval (CI): 1.7-13.9, p = 0.003), and for morbidity risk, was 2.8 (95% CI: 1.4-5.4, p = 0.003). CONCLUSIONS Patients on dialysis have an increased morbidity and mortality following cardiac surgery, however we believe ESRF should not be regarded as an absolute contraindication to cardiac surgery or cardiopulmonary bypass.
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Affiliation(s)
- Adam D Zimmet
- Cardiothoracic Surgery Unit, Monash Medical Centre, Department of Surgery, Level 5, E Block, Monash University, 246 Clayton Road, Clayton, Vic. 3168, Australia
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Witczak B, Hartmann A, Svennevig JL. Multiple Risk Assessment of Cardiovascular Surgery in Chronic Renal Failure Patients. Ann Thorac Surg 2005; 79:1297-302. [PMID: 15797066 DOI: 10.1016/j.athoracsur.2004.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Chronic renal failure is a major risk factor in cardiovascular surgery. We evaluated results of cardiovascular surgery in chronic renal failure patients (s-creatinine > 200 micromol/L or established dialysis) at our center from 1990 to 2000. METHODS One hundred and six chronic renal failure patients underwent cardiovascular surgery (56 coronary artery bypass operations, 25 valve replacements with or without coronary bypass, and 25 other major cardiovascular operations [8 thoracic aorta, 10 abdominal aorta, 7 other]). Matched controls were selected (n = 106) based on age, sex, year, and type of operation and occurrence of diabetes. RESULTS There were 88 men and 18 women and mean age was 64 +/- 10 years (standard deviation). Demographics did not differ between chronic renal failure and control patients, except for hypertension (more prevalent in chronic renal failure group, p < 0.05). Intraoperative hemorrhage, perfusion and ischemia time, and reoperation did not differ between groups. Chronic renal failure patients received more transfusions of red blood cells, plasma, and platelets (p < 0.02). Ventilation support (27.6 +/- 59.3 hours), intensive care unit stay (7.7 +/- 8.3 days), and hospital stay (12.3 +/- 10.5 days) were longer (p < 0.02). Early mortality was 16% versus 6.6% (p = 0.04) and 5-year mortality was 79% versus 39% (p < 0.05) for chronic renal failure and control patients, respectively. Independent preoperative risk factors of mortality for chronic renal patients were age greater than 70 years (relative risk = 2.32, p = 0.001), chronic obstructive pulmonary disease (relative risk = 2.59, p = 0.001), diabetes (relative risk = 1.80, p = 0.037), and dialysis (relative risk = 2.03, p = 0.005). CONCLUSIONS Chronic renal failure patients suffered more postoperative complications and had substantially increased short-term and long-term mortality rates. Independent preoperative mortality risk factors for chronic renal failure patients were age, chronic obstructive pulmonary disease, diabetes, and chronic dialysis.
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Affiliation(s)
- Bartlomiej Witczak
- Department of Medicine, Section of Nephrology, Rikshospitalet University Hospital, University of Oslo, Oslo, Norway.
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Beauford RB, Saunders CR, Niemeier LA, Lunceford TA, Karanam R, Prendergast T, Shah S, Burns P, Sardari F, Goldstein DJ. Is off-pump revascularization better for patients with non-dialysis-dependent renal insufficiency? Heart Surg Forum 2004; 7:E141-6. [PMID: 15138092 DOI: 10.1532/hsf98.200330203] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Renal dysfunction is a well-recognized complication following coronary artery bypass grafting (CABG). Coronary revascularization without cardiopulmonary bypass (CPB) has been shown to minimize renal injury in patients with normal preoperative renal function who undergo elective procedures. The purpose of this study was to define the effect of an off-pump revascularization strategy on the incidence of postoperative renal failure and survival of patients with preexisting renal dysfunction. METHODS From January 1, 1999, to December 1, 2002, a total of 371 patients were identified as having a preoperative creatinine concentration greater than or equal to 1.5 mg/dL. This number included 291 patients who did not need hemodialysis or peritoneal dialysis to support renal function. These patients were subdivided into those undergoing traditional CABG with CPB (103 patients) and those undergoing off-pump revascularization (188 patients) whose demographic, operative, and outcome information was retrospectively reviewed and compared. RESULTS The off-pump cohort was older than the on-pump cohort (70 +/- 9.6 versus 66 +/- 10.9 years; P =.002), had a lower prevalence of previous myocardial infarction (35% versus 50%; P =.008), and had a modestly higher mean left ventricular ejection fraction (0.47 +/- 0.01 versus 0.43 +/- 0.01; P =.017). Otherwise the groups were well matched. The mean preoperative serum creatinine and creatinine clearance values were not significantly different (1.8 +/- 0.5 versus 1.9 +/- 0.6 mg/dL [ P =.372] and 45.1 +/- 15.5 versus 46.8 +/- 17.2 mL/min [ P =.376] for the off-pump and on-pump cohorts, respectively). There was a significant reduction in postoperative renal failure (17% versus 9% of patients; P =.020) and need for new dialysis (10% versus 3% of patients; P =.022) when CPB was eliminated. Intermediate-term survival analysis revealed a survival benefit for the off-pump group (70% versus 57%) at 42 months, although this value did not reach statistical significance ( P =.143). CONCLUSION The results of this study suggested that patients with preoperative non-dialysis-dependent renal insufficiency have more favorable outcome when revascularization is done off pump. Avoidance of CPB results in (1) a reduction in the incidence of postoperative renal failure; (2) a reduction in the need for new dialysis; and (3) improved in-hospital and midterm survival.
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Affiliation(s)
- Robert B Beauford
- Departments of Cardiothoracic Surgery, Newark Beth Israel Medical Center, USA.
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