Cardiac catheterization within 24 hours of valve surgery is significantly associated with acute renal failure.
Summary of "Cardiac catheterization within 24 hours of valve surgery is significantly associated with acute renal failure."
OBJECTIVE:
Acute renal failure after valve surgery carries significant morbidity and mortality. Preoperative cardiac catheterization is the standard of care. For convenience, catheterization just before surgery is simplest for patients. However, it is not known if this timing of radiocontrast administration significantly affects renal function. We hypothesized that preoperative cardiac catheterization within 24 hours of valve surgery is associated with the development of acute renal failure.
METHODS:
A retrospective case-control study was performed of all patients undergoing valve surgery between 2003 and 2008 at the University of Virginia. Patients with preoperative renal dysfunction were excluded. Patients with postoperative acute renal failure were matched to those without acute renal failure according to age, gender, year of surgery, New York Heart Association functional class, elective status, concomitant coronary artery bypass grafting, and type of valve procedure. A logistic regression model examined the effects of perioperative risk factors on the development of acute renal failure.
RESULTS:
Of 1287 patients undergoing valve surgery, 61 with acute renal failure were matched to 136 without acute renal failure. Cardiac catheterization within 24 hours of surgery was significantly greater in patients with acute renal failure (31.2% vs 8.8%, P = .013). The risk of acute renal failure was more than 5 times higher for patients undergoing catheterization within 24 hours of surgery (odds ratio, 5.3; P = .004). The number of postoperative vasopressors was significantly associated with acute renal failure (odds ratio, 1.7; P = .007).
CONCLUSIONS:
Although catheterization is often performed for patient convenience, catheterization within 24 hours of valve surgery is significantly associated with the development of acute renal failure. Current practices should be adjusted to ensure that more than 24 hours have passed from the time of cardiac catheterization to valve surgery in elective settings.
Affiliation
Department of Surgery, University of Virginia, Charlottesville, Va.
Journal Details
This article was published in the following journal.
Name: The Journal of thoracic and cardiovascular surgery
ISSN: 1097-685X
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20828767
- DOI: http://dx.doi.org/10.1016/j.jtcvs.2010.07.056
Medical and Biotech [MESH] Definitions
Cardiac Valve Annuloplasty
A type of heart valve surgery that involves the repair, replacement, or reconstruction of the annuli of HEART VALVES. It includes shortening the circumference of the annulus to improve valve closing capacity and reinforcing the annulus as a step in more complex valve repairs.
Mitral Valve Annuloplasty
A type of heart valve surgery that involves the repair, replacement, or reconstruction of the annulus of the MITRAL VALVE. It includes shortening the circumference of the annulus to improve valve closing capacity and reinforcing the annulus as a step in more complex valve repairs.
Mitral Valve Prolapse
Abnormal protrusion or billowing of one or both of the leaflets of MITRAL VALVE into the LEFT ATRIUM during SYSTOLE. This allows the backflow of blood into left atrium leading to MITRAL VALVE INSUFFICIENCY; SYSTOLIC MURMURS; or CARDIAC ARRHYTHMIA.
Carcinoid Heart Disease
Cardiac manifestation of gastrointestinal CARCINOID TUMOR that metastasizes to the liver. Substances secreted by the tumor cells, including SEROTONIN, promote fibrous plaque formation in ENDOCARDIUM and its underlying layers. These deposits cause distortion of the TRICUSPID VALVE and the PULMONARY VALVE eventually leading to STENOSIS and valve regurgitation.
Ventricular Pressure
The pressure within a CARDIAC VENTRICLE. Ventricular pressure waveforms can be measured in the beating heart by catheterization or estimated using imaging techniques (e.g., DOPPLER ECHOCARDIOGRAPHY). The information is useful in evaluating the function of the MYOCARDIUM; CARDIAC VALVES; and PERICARDIUM, particularly with simultaneous measurement of other (e.g., aortic or atrial) pressures.
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