Acute kidney injury after heart valve surgery in elderly patients: any risk factors to modify?

Abstract Introduction: Postoperative acute kidney injury contributes to longer hospital stays and increased costs related to cardiac surgery in the elderly. We analyse the influence of the patient's age on risk factors for acute kidney injury after cardiac valve surgery. Methods: We evaluated the prevalence and risk factors for acute kidney injury in 939 consecutive patients undergoing valve surgery, between 2013 and 2018. Results: The prevalence of acute kidney injury was 19.5%. Hypertension (P=0.017); RR (95% CI): 1.74 (1.10-3.48), age ≥70 years (P=0.006); RR (95% CI): 1.79 (1.17-2.72), preoperative haematocrit <33% (P=0.009); RR (95% CI): 2.04 (1.19-3.48), glomerular filtration rate <60 ml/min/1.73 m2 (P<0.0001); RR (95%) CI: 2.36 (1.54-3.62) and cardiac catheterization <8 days before surgery (P=0.021); RR (95% CI): 2.15 (1.12-4.11) were identified as independent risk factors. In patients older than 70 years, with no kidney disease diagnosed preoperatively, glomerular filtration rate <70 ml/min/1.73 m2, male gender, cardiopulmonary bypass time, preoperative haematocrit <36% and preoperative therapy with angiotensin-converting enzyme inhibitors were risk factors for acute kidney injury after valve surgery. Conclusions: In elderly patients, postoperative acute kidney injury develops with higher values of preoperative glomerular filtration rate than those observed in a younger population. Preoperative correction of anaemia, discontinuation of angiotensin-converting enzyme inhibitors and surgical techniques reducing cardiopulmonary bypass time would be considered to reduce the prevalence of renal failure.

Predictors of postoperative acute kidney injury after coronary artery bypass graft surgery

Abstract Objective: The aims of this study were to identify the risk factors associated with acute kidney injury (AKI) after isolated surgical revascularization with cardiopulmonary bypass and to develop a model to predict the appearance of postoperative AKI. Methods: A total of 435 adult patients who underwent primary isolated coronary artery bypass graft (CABG) surgery, from 2012 to 2016, in the Clinic University Hospital of Valladolid (Spain) were enrolled. AKI was defined according to the risk, injury, failure, loss, and end-stage (RIFLE) criteria. Data were collected from hospital electronic medical records. Multiple logistic regression analysis was used to identify risk factors. Results: The prevalence of AKI was 12.4%. Multivariate analysis identified age (odds ratio [OR], 1.056; 95% confidence interval [CI], 1.016-1.098; P=0.005), hypertension (OR, 3.078; 95% CI, 1.151-8.230; P=0.018), low ejection fraction (EF) (OR, 6.785; 95% CI, 2.080-22.135; P=0.001), estimated glomerular filtration rate (eGFR) (OR, 1.017; 95% CI, 1.005-1.028; P=0.014), EuroSCORE II (OR, 1.049; 95% CI, 1.004-1.096; P=0.033), and no intake of calcium-channel blockers (CCB) (OR, 4.892; 95% CI, 1.496-16.025; P=0.022) as risk factors for AKI. These risk factors were included in a model to predict postoperative AKI with an area under a receiver operating characteristic curve of 0.783±0.036 (95% CI, 0.713-0.854; P<0.0001). Conclusion: Age, hypertension, low EF, eGFR, EuroSCORE II, and no intake of CCB were independent risk factors for postoperative AKI. These factors provide an easy and accurate model to predict postoperative AKI in patients undergoing cardiac surgery.

Revascularización miocárdica en la población femenina / Myocardial revascularization in the female population

OBJECTIVES: To analyze the factors that influence outcomes of surgical myocardial revascularization in the female population. PATIENTS AND METHOD: This is a retrospective study in which 128 woman, subjected to GABC[IBM1] from January to September 2004, were enrolled in an univariate and multivariate analysis of risk factors associated with morbidity and mortality. Results: The mean age was 69.19 +/- 9.05 [IBM2] years, the most frequent pathologies, comorbilities, were dyslipemia, hypertension, and myocardial infarction. Unestable angina was found in 63.28% patients and stenosis in the left main coronary artery 42.96%; NYHA III-IV in 23.43%. The EuroSCORE mean preoperative risk was [IBM3] 5.57. Twelve surgeries were emergencies. Mean of grafts was 2.57. Mortality corresponded to 5.4% in programmed surgeries, 7% global. Univariate analysis identified this risk factors releated to mortality (p < 0.05): age older than 67 years, NYHA III-IV and emergency surgery, complicated in 25.2%. Follow-up was kept in 90.8% of patients, mean follow-up time was 17.11 (+/- 14.94) months; 115 patients did not present angina. The risk factor for angina during follow-up, in the univariate analysis (p < 0.05) was not having used the left internal thoracic artery as graft for the anastomosis of the anterior descending artery. CONCLUSIONS: Emergency surgery, age older than 67 years, and NYHA III-IV, were independent risk factors associated with mortality in this group. The use of artery grafts associated to reduced angina during follow-up.

Disección espontánea de la arteria coronaria descendente anterior tratada mediante cirugía sin circulación extracorpórea / Surgical treatment of a spontaneous dissection of the left anterior descending coronary artery without the use of cardiopulmonary bypass

Se presenta un caso de disección espontánea de la arteria coronaria descendente anterior en una mujer de 51 años, sin relación con factores desencadenantes conocidos. El inicio clínico fue un IAM no Q anterior, controlado con tratamiento médico y buena evolución clínica. El cateterismo cardíaco evidenció la disección de la arteria descendente anterior, que producía deterioro de la función sistólica. Se realizó revascularización arterial urgente mediante injerto de mamaria interna izquierda a descendente anterior sin CEC. El posoperatorio cursó sin complicaciones y a 25 meses del procedimiento la paciente se encuentra asintomática. Se realiza, además, una exposición de las consideraciones clínicas relacionadas con esta patología.

Troca de valva com a prótese valvar modelo Omnicarbon: seguimento clínico de 10 anos / Valve replacement with the Omnicarbon valve prosthesis: a 10-year follow-up

OBJETIVO: Estudar retrospectivamente os resultados de 264 pacientes submetidos à implementação cirúrgica de válvula modelo Omnicarbon entre abril 1985 e maio 1995. MÉTODOS: No momento da cirurgia, a média de idade dos pacientes que receberam essa prótese mecânica era de 57±11 anos. As válvulas modelo Omnicarbon foram colocadas em posição aórtica em 36 por cento dos casos, na posição mitral em 44 por cento dos casos, e nas duas posições em 20 por cento dos casos. O seguimento clínico foi feito cuidadosamente, com a maioria dos pacientes submetidos ao exame físico em nossa clínica. Levando em conta o histórico do caso, os cardiologistas faziam perguntas aos pacientes sobre as complicações relacionadas à válvula. RESULTADOS: O seguimento acumulado dos pacientes foi de 1291 anos, com média de seguimento de 5,4 anos. A sobrevida após 10 anos foi de 79,4±3,9 por cento, incluindo todas as causas de morte e os casos de mortalidade precoce. As complicações relatadas durante os 11 anos de estudo incluem: tromboembolismo (0,1 por cento), hemorragia (0,4 por cento), endocardite (0,2 por cento), e insuficiência não-estrutural (1,2 por cento). Não foram detectadas anemia hemolítica, trombose valvar, ou insuficiência estrutural durante esse longo período de estudo. A capacidade funcional desses pacientes foi avaliada subjetivamente pelo sistema de classificação da NYHA. Com o tempo de seguimento maior do que 5 anos em média, nossos pacientes que receberam a válvula modelo Omnicarbon se encontram na classe I ou II da NYHA. CONCLUSAO: As próteses mecânicas modelo Omnicarbon apresentam um bom desempenho clínico por até 10 anos, tanto em posição aórtica quanto mitral. Os resultados indicam uma baixa incidência de tromboembolismo e complicações hemorrágicas.