Risk Analysis And Outcomes Of Postoperative Renal Failure Following Aortic Valve Surgery In The Us.
BACKGROUND: Postoperative renal failure(RF) compromises early outcomes in cardiac surgery. In contrast, long-term survival and progression of RF following aortic valve replacement(AVR) with or without coronary artery bypass grafting(CABG) remain undefined. METHODS: From 2008 through 2015, records of AVR±CABG in the Society of Thoracic Surgeons(STS) database were linked to Medicare claims data. Postoperative RF was categorized as with(RF-D) or without new dialysis(RF-no-D). Cox proportional-hazard models were used to conduct a risk analysis and evaluate outcomes in this patient group. RESULTS: Of 164,727 AVR±CABG patients, 3.5% developed postoperative RF, of which 63.3% required dialysis. Operative mortality of postoperative RF was 39.2%, higher for RF-D vs RF-no-D(46.1% vs 26.1%, p<0.0001). Both RF-D and RF-no-D had a higher early(<30 days) mortality risk(hazard ratio [HR]:11.29, p<0.0001 and HR:8.03, p<0.0001, respectively) compared to no postoperative RF. At a median follow-up of 2.7 years, RF-D and RF-no-D remained relevant risk factors, however, with a lower magnitude of effect(HR:2.42; p<0.0001 and HR:1.69, p<0.0001, respectively). Preoperative glomerular filtration rate(GFR)<30 mL/min/1.73 m2 had a lower early(HR:0.48, p<0.0001), but higher late(HR:1.5, p<0.0001) mortality risk compared to GFR>60. Predictors for long-term progression to RF-D included preoperative GFR<30(HR:13, p<0.0001), GFR 30-60(HR:2.47, p=0.006), and insulin-dependent diabetes(HR:1.96, p=0.001). CONCLUSIONS: Postoperative RF following AVR±CABG was associated with a higher early and late mortality, which further increased with a new requirement for dialysis. Once postoperative RF develops, preoperative renal dysfunction does not increase early mortality, however, predicts late survival. Preoperative renal function is associated with progression of postoperative RF to dialysis.
Polo, MC; Thibault, D; Thourani, VH; Badhwar, V; Xian, Y; Shemin, RJ
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