National clinical and financial outcomes associated with acute kidney injury following esophagectomy for cancer.

BACKGROUND: Esophagectomy is a complex oncologic operation associated with high rates of postoperative complications. While respiratory and septic complications have been well-defined, the implications of acute kidney injury (AKI) remain unclear. Using a nationally representative database, we aimed to characterize the association of AKI with mortality, resource use, and 30-day readmission. METHODS: All adults undergoing elective esophagectomy with a diagnosis of esophageal or gastric cancer were identified in the 2010-2019 Nationwide Readmissions Database. Study cohorts were stratified based on presence of AKI. Multivariable regressions and Royston-Parmar survival analysis were used to evaluate the independent association between AKI and outcomes of interest. RESULTS: Of an estimated 40,438 patients, 3,210 (7.9%) developed AKI. Over the 10-year study period, the incidence of AKI increased from 6.4% to 9.7%. Prior radiation/chemotherapy and minimally invasive operations were associated with reduced odds of AKI, whereas public insurance coverage and concurrent infectious and respiratory complications had greater risk of AKI. After risk adjustment, AKI remained independently associated with greater odds of in-hospital mortality (AOR: 4.59, 95% CI: 3.62-5.83) and had significantly increased attributable costs ($112,000 vs $54,000) and length of stay (25.7 vs 13.3 days) compared to patients without AKI. Furthermore, AKI demonstrated significantly increased hazard of 30-day readmission (hazard ratio: 1.16, 95% CI: 1.01-1.32). CONCLUSIONS: AKI after esophagectomy is associated with greater risk of mortality, hospitalization costs, and 30-day readmission. Given the significant adverse consequences of AKI, careful perioperative management to mitigate this complication may improve quality of esophageal surgical care at the national level.

Center-Level Variation in Hospitalization Costs of Transcatheter Aortic Valve Replacement.

BACKGROUND: Using a nationally representative database, the present study evaluated the degree of center-level variation in the cost of transcatheter aortic valve replacement (TAVR). METHODS: All adults undergoing elective, isolated TAVR were identified in the 2016 to 2018 Nationwide Readmissions Database. Multilevel mixed-effects models were used to identify patient and hospital characteristics associated with hospitalization costs. The random intercept for each hospital was generated and considered to be the baseline cost attributable to care at each center. Hospitals in the highest decile of baseline costs were classified as high-cost hospitals. The association of high-cost hospital status with in-hospital mortality and perioperative complications was subsequently assessed. RESULTS: An estimated 119,492 patients, with a mean age of 80 years and a 45.9% prevalence of female sex, met the study criteria. Analysis of random intercepts indicated that 54.3% of variability in costs was attributable to interhospital differences rather than patient factors. Perioperative respiratory failure, neurologic complications, and acute kidney injury were associated with increased episodic expenditure but did not explain the observed center-level variation. The baseline cost associated with each hospital ranged from -$26,000 to $162,000. Notably, high-cost hospital status was not linked to annual TAVR caseload or to odds of mortality (P = .83), acute kidney injury (P = .18), respiratory failure (P = .32), or neurologic complications (P = .55). CONCLUSIONS: The present analysis identified significant variation in the cost of TAVR, which was largely attributable to center-level rather than patient factors. Hospital TAVR volume and occurrence of complications were not drivers of the observed variation.

Impact of Pulmonary Complications on Outcomes and Resource Use After Elective Cardiac Surgery.

OBJECTIVE: To characterize the impact of pulmonary complications (PCs) on mortality, costs, and readmissions after elective cardiac operations in a national cohort and to test for hospital-level variation in PC. BACKGROUND: PC after cardiac surgery are targets for quality improvement efforts. Contemporary studies evaluating the impact of PC on outcomes are lacking, as is data regarding hospital-level variation in the incidence of PC. METHODS: Adults undergoing elective coronary artery bypass grafting and/or valve operations were identified in the 2016-2019 Nationwide Readmissions Database. PC was defined as a composite of reintubation, prolonged (>24 hours) ventilation, tracheostomy, or pneumonia. Generalized linear models were fit to evaluate associations between PC and outcomes. Institutional variation in PC was studied using observed-to-expected ratios. RESULTS: Of 588,480 patients meeting study criteria, 6.7% developed PC. After risk adjustment, PC was associated with increased odds of mortality (14.6, 95% CI, 12.6-14.8), as well as a 7.9-day (95% CI, 7.6-8.2) increase in length of stay and $41,300 (95% CI, 39,600-42,900) in attributable costs. PC was associated with 1.3-fold greater hazard of readmission and greater incident mortality at readmission (6.7% vs 1.9%, P <0.001). Significant hospital-level variation in PC was present, with observed-to-expected ratios ranging from 0.1 to 7.7. CONCLUSIONS: Pulmonary complications remain common after cardiac surgery and are associated with substantially increased mortality and expenditures. Significant hospital-level variation in PC exists in the United States, suggesting the need for systematic quality improvement efforts to reduce PC and their impact on outcomes.

Retained entrapped coronary stent appearing like an aortic flap.

Entrapment of coronary angioplasty hardware is a rare but serious complication of coronary interventions which may be managed percutaneously or surgically. We described a case of an entrapped coronary stent in a patient with a history of failed coronary intervention with no documents available. In transesophageal echocardiography, there was a linear echo density in the ascending aorta stuck in the right coronary artery resembling a dissection flap but based on the history of failed coronary intervention, this odd structure was supposed to be a retained angioplasty device. The patient underwent surgical removal of the entrapped device which was a fractured stent.

Ruptured mitral valve aneurysm: A devastating complication of aortic valve endocarditis.

Mitral valve aneurysm is a rare clinical entity that is mostly resulted from infective endocarditis, in particular, aortic valve endocarditis. Once mitral valve aneurysm ruptures and severe mitral regurgitation and hemodynamic instability develop, prompt surgery should be considered. Here we report a patient with ruptured mitral valve aneurysm associated with native aortic valve endocarditis that was improved after a successful mitral and aortic valve replacement surgery associated with antibiotic therapy for 6 weeks.

Endovascular Aortic Aneurysm and Dissection Repair (EVAR) in Iran: Descriptive Midterm Follow-up Results.

BACKGROUND: Endovascular repair of aorta in comparison to open surgery has a low early operative mortality rate, but its long-term results are uncertain. OBJECTIVES: The current study describes for the first time our initial four-year experience of elective endovascular aortic repair (EVAR) at Tehran heart center, the first and a major referral heart center in Iran, as a pioneer of EVAR in Iran. PATIENTS AND METHODS: A total of 51 patients (46 men) who had the diagnosis of either an abdominal aortic aneurysm (AAA) (n = 36), thoracic aortic aneurysm (TAA) (n = 7), or thoracic aortic dissection (TAD) (n = 8) who had undergone EVAR by Medtronic stent grafts by our team between December 2006 and June 2009 were reviewed. RESULTS: The rate of in-hospital aneurysm-related deaths in the group with AAA stood at 2.8% (one case), while there was no in-hospital mortality in the other groups. All patients were followed up for 13-18 months. The cumulative death rate in follow-up was nine cases from the total 51 cases (18%), out of which six cases were in the AAA group (four patients due to non-cardiac causes and two patients due to aneurysm-related causes), one case in the TAA group (following a severe hemoptysis), and two cases in the TAD group (following an expansion of dissection from re-entrance). The major event-free survival rate was 80.7% for endovascular repair of AAA, 85.7% for endovascular repair of TAA, and 65.6% for endovascular repair of TAD. CONCLUSION: The endovascular stent-graft repair of the abdominal and thoracic aortic aneurysm and aortic dissection had high technical success rates in tandem with low-rate early mortality and morbidity, short hospital stay, and acceptable mid-term free symptom survival among Iranian patients.

Early outcome of off-pump versus on-pump coronary revascularization.

INTRODUCTION: The use of coronary artery bypass surgery (CABG) with cardiopulmonary bypass (CPB) or without CPB technique (off-pump) can be associated with different mortality and morbidity and their outcomes remain uncertain. The goal of this study was to evaluate the early outcome of on-pump versus off-pump CABG. METHODS: We conducted a retrospective database review of 13866 patients (13560 patients undergoing on-pump CABG and 306 patients undergoing off-pump CABG) at Tehran Heart Center between January 2002 and January 2007. We compared preoperative, operative, and postoperative characteristics between them. RESULTS: In-hospital mortality in the on-pump group was 0.8% compared to 0.7% in the off-pump group (P=0.999) and in-hospital morbidity was 11.7% and 6.5%, respectively (OR: 1.533, 95%CI: 0.902-2.605, P=0.114). Postoperative atrial fibrillation was more prevalent in on-pump versus off-pump surgery (6.0% vs 3.0%, P=0.028), however there were no statistical significant differences in other postoperative complications with regard to cardiac arrest (P=0.733), prolonged ventilation (P=0.363), brain stroke (P=0.999), renal failure (P=0.525), and postoperative bleeding (P=0.999). The mean length of stay in hospital (P=0.156) and in ICU (P=0.498) was also similar between the two groups. CONCLUSION: The results from an Iranian population-based study showed similar early mortality and morbidity of off-pump CABG in comparison to on-pump surgery.

Extraluminal atherosclerosis: an under-recognised finding in human aortocoronary venous bypass grafts.

BACKGROUND: Coronary artery bypass grafting (CABG) is commonly compromised by graft atherosclerosis. Histopathologic studies confirm various forms of atherosclerosis, including positively remodelled lesions in native coronary arteries but there are no histopathologic reports of extraluminal atherosclerosis in vein grafts. METHODS: We prospectively investigated the histopathologic presence and pattern of extraluminal atherosclerosis in human old vein grafts in a two-year interval among patients undergoing redo-CABG at three university hospitals in Tehran. We separately documented clinical and angiographic findings. RESULTS: We evaluated 100 segments from 20 human old vein grafts obtained during the redo CABG. All but four segments demonstrated some degrees of luminal narrowing. Luminal atherosclerotic plaques were detectable in 61 segments. We detected extraluminal atheroscleoris in seven segments. Mean vessel wall thickness was greater in segments containing extraluminal plaques (1.41±0.26 mm versus 0.91±0.04 mm, P=0.008). Angiographic findings had a modest correlation with presence or absence of luminal atheromatous lesions (Spearman's rho: 0.331, P=0.007). Angiographic degree of stenosis could not predict the presence of positively remodelled atherosclerotic plaques (Spearman's rho: -2.21, P=0.073). CONCLUSION: Previous studies suggested positive remodelling in vein grafts. Out study provides histopathologic evidence on extraluminal atherosclerosis in human aortocoronary vein grafts.

Histopathologic insight into saphenous vein bypass graft disease.

OBJECTIVES: Vein graft disease is a major drawback of coronary artery bypass grafting. However, histopathologic studies of old human aortocoronary grafts are scarce. METHODS: We screened patients undergoing redo coronary artery bypass grafting at three university hospitals and selected those with at least one excisable old vein graft. Native non-grafted saphenous veins were also obtained as controls. Clinical and angiographic data were separately documented. RESULTS: We evaluated 117 segments from 29 veins. All but 4 old graft segments showed degrees of luminal narrowing and fibrointimal proliferation. Moreover, 61 segments demonstrated atherosclerotic plaques. Such plaques were typically concentric and, compared with other segments, more frequently represented necrosis, calcification and giant cells (p < 0.001 for all comparisons) and had a higher inflammatory cell count, predominantly of lymphocytic origin. Native saphenous veins frequently showed fibrosis, but no calcification or active inflammation. Angiographic findings showed moderate correlation with the histological degree of luminal stenosis (Spearman's ρ = 0.564, p < 0.001). CONCLUSIONS: Human vein graft atherosclerosis and arterial atherosclerosis share many features; however, we found lymphocytes to be the dominant inflammatory cells within plaques. Conventional angiography underestimated the atherosclerosis burden in vein grafts. Improved understanding of disease pathophysiology could lead to the development of novel interventions that reduce costly and suboptimal repeat revascularizations.

Predictors and early outcome of prolonged mechanical ventilation in contemporary heart valve surgery.

BACKGROUND: During last decades mechanical ventilation has been an important support in the postoperative management of patients undergoing cardiac surgery. This study was designed to determine the predictors of prolonged mechanical ventilation (PMV) in patients undergoing heart valve surgery. METHODS: This retrospective study considered of 1056 patients who underwent isolated valve surgery at Tehran Heart Center from March 2002 to March 2009. PMV is considered as mechanical ventilation period of > or =24 hours at postoperative hospital stay in this study. RESULTS: PMV occurred in 6.6% of patients. Initial ventilation hours, atrial fibrillation, cardiac arrest and reintubation were the most prevalent postoperative complications. Preoperative renal failure, postoperative stroke, intra aortic balloon pump insertion, emergent operation, complete heart block, longer perfusion time were independent predictors of PMV in our patients. CONCLUSION: PMV is associated with significant comorbidities and increased hospital mortality. Strategies to delineate the patients at risk and to modify these risk factors by prophylactic measures should probably lead to a lower incidence of prolonged mechanical ventilation for patients undergoing isolated valve surgery.

Determinants of postoperative atrial fibrillation and associated resource utilization in cardiac surgery.

INTRODUCTION AND OBJECTIVES: Atrial arrhythmias occur after cardiac surgery in 10-65% of patients. The most common postoperative arrhythmia is atrial fibrillation (AF). METHODS: The Tehran Heart Center Cardiovascular Research database (of 15 580 patients) was used to identify all patients who developed any form of AF as a postoperative complication following their first cardiac surgery (e.g. for coronary artery bypass grafting [CABG], valve surgery or both), with and without cardiopulmonary bypass, between June 2002 and March 2008. RESULTS: Of the 15 580 patients who underwent a first cardiac surgery, 11 435 (73.4%) were male and their mean age was 58.16+/-10.11 years. New-onset AF developed postoperatively in 1129 (7.2%). New-onset AF occurred most frequently in patients who were aged > or =60 years and who had no history of beta-blocker use. In addition, patients were more likely to develop new-onset AF if they had valve surgery alone (16.5%) or CABG plus valve surgery combined (9.6%), needed intra-aortic balloon counterpulsation (IABC), or had a long cardiopulmonary bypass time. Multivariate analysis identified the following predictors of postoperative AF: older age, history of renal failure, congestive heart disease, operation type, longer perfusion time, and use of IABC. The incidence of early readmission (4.4%) was significantly higher in patients with postoperative AF, as was the duration of hospitalization, both overall and postoperatively. The short-term postoperative mortality rate was 3.8%. CONCLUSIONS: Atrial fibrillation frequently develops after cardiac surgery and is associated not only with increased morbidity and mortality, but also with increased use of health-care resources.

Factores determinantes de fibrilación auricular postoperatoria y el uso de recursos en cirugía cardiaca / Determinants of postoperative atrial fibrillation and associated resource utilization in cardiac surgery

Introducción y objetivos. Las arritmias auriculares tras cirugía cardiaca se dan en un 10-65% de los pacientes. La fibrilación auricular (FA) es la arritmia más frecuente tras la cirugía cardiaca. Métodos. Se utilizó la base de datos para investigación cardiovascular del Tehran Heart Center (15.580 pacientes) para identificar a todos los pacientes que presentaron algún tipo de FA como complicación postoperatoria tras su primera intervención de cirugía cardiaca (bypass arterial coronario, cirugía valvular o bypass más cirugía valvular) con o sin bypass cardiopulmonar (BCP), entre junio de 2002 y marzo de 2008. Resultados. De los 15.580 pacientes a los que se practicó una primera operación de cirugía cardiaca, 11.435 (73,4%) eran varones con una media de edad de 58,16 ± 10,11 años. Se produjo una FA postoperatoria de nueva aparición en 1.129 (7,2%) de estos pacientes. La FA de nueva aparición fue más frecuente en los pacientes de edad ≥ 60 años que no tenían antecedentes de tratamiento con bloqueadores beta. Los pacientes con una FA de nueva aparición tenían también mayor probabilidad de que se les hubiera practicado una operación de cirugía valvular (16,5%) o de bypass más cirugía valvular (9,6%), así como de necesidad de balón de contrapulsación intraaórtico (BCIA) y un tiempo de bypass cardiopulmonar mayor. Los factores predictivos de la aparición de FA postoperatoria en el análisis multivariable fueron la mayor edad, los antecedentes de insuficiencia renal, la insuficiencia cardiaca congestiva, el tipo de operación, el mayor tiempo de perfusión y el uso de BCIA. En los pacientes con FA postoperatoria hubo una incidencia significativamente superior de reingresos tempranos (4,4%), así como una duración de la hospitalización (DdH) y una DdH postoperatoria más prolongadas. La tasa de mortalidad postoperatoria temprana fue del 3,8%. Conclusiones. La aparición de FA es frecuente tras la cirugía cardiaca y se asocia no sólo a un aumento de la morbimortalidad, sino también a un incremento de la utilización de recursos (AU)

Introduction and objectives. Atrial arrhythmias occur after cardiac surgery in 10-65% of patients. The most common postoperative arrhythmia is atrial fibrillation (AF). Methods. The Tehran Heart Center Cardiovascular Research database (of 15 580 patients) was used to identify all patients who developed any form of AF as a postoperative complication following their first cardiac surgery (e.g. for coronary artery bypass grafting [CABG], valve surgery or both), with and without cardiopulmonary bypass, between June 2002 and March 2008. Results. Of the 15 580 patients who underwent a first cardiac surgery, 11 435 (73.4%) were male and their mean age was 58.16±10.11 years. New-onset AF developed postoperatively in 1129 (7.2%). New-onset AF occurred most frequently in patients who were aged ≥60 years and who had no history of beta-blocker use. In addition, patients were more likely to develop new-onset AF if they had valve surgery alone (16.5%) or CABG plus valve surgery combined (9.6%), needed intra-aortic balloon counterpulsation (IABC), or had a long cardiopulmonary bypass time. Multivariate analysis identified the following predictors of postoperative AF: older age, history of renal failure, congestive heart disease, operation type, longer perfusion time, and use of IABC. The incidence of early readmission (4.4%) was significantly higher in patients with postoperative AF, as was the duration of hospitalization, both overall and postoperatively. The short-term postoperative mortality rate was 3.8%. Conclusions. Atrial fibrillation frequently develops after cardiac surgery and is associated not only with increased morbidity and mortality, but also with increased use of health-care resources (AU)

Screening of carotid artery stenosis in coronary artery bypass grafting patients.

BACKGROUND: We sought to evaluate the routine echo-Doppler screening of carotid artery stenosis in patients undergoing coronary artery bypass grafting. METHODS: A total of 2179 consecutive patients who underwent coronary artery bypass grafting alone or with other cardiac surgery at Tehran Heart Center, Tehran-Iran, between January 2005 and January 2006 were included in this retrospective study. Carotid Doppler was performed for 1604 (81.48%) of these patients. RESULTS: The patients' age ranged between 20 and 84 years (mean: 58.33, SD: 10.08 years). Of the 1604 patients studied, 1186 (73.9%) were men, 592 (36.9%) had diabetes, 598 (37.3%) were smokers, and 194 (12.1%) cases had significant left main stenosis. Twenty-one (1.3%) patients had significant carotid stenosis (> 60% stenosis), which constituted 0.9% of all the bypass surgery candidates. Post-operative cerebrovascular accident was not detected in any of the patients with significant carotid stenosis, but cerebrovascular accident occurred in 22 (1.4%) of the patients without carotid stenosis. Magnetic resonance angiography (MRA) was conducted in 15 patients. In our univariate analysis, female gender (p value = 0.023), hypertension (p value = 0.055), peripheral vascular disease (p value < 0.001), and age (p value = 0.001) were significant in the development of carotid stenosis. CONCLUSION: Pre-operative duplex carotid screening seems to be necessary in patients when there is hypertension, peripheral vascular disease, female gender, and advanced age.

Is severely left ventricular dysfunction a predictor of early outcomes in patients with coronary artery bypass graft?

BACKGROUND: Traditionally, the Coronary artery bypass grafting (CABG) surgery outcomes of patients with low ejection fraction (EF) have been worse compared to patients with moderate to good left ventricular function. During the past decade, despite improvements in surgical techniques, the trend in the outcomes of these patients remained unclear. AIM: We sought to determine the effect of left ventricular dysfunction on early mortality and morbidity and to specify predictors of early mortality of isolated CABG in a large group of patients EF≤35%. METHOD: We retrospectively analyzed data of 14 819 consecutive patients undergoing isolated CABG from February 2002 to March 2008 at Tehran Heart Center. Patients were divided into two groups based on their LVEF (EF≤35% and EF>35%). Differences in case-mix between patients with EF≤35% and those without were controlled by constructing a propensity score. RESULTS: Mean age of our patients was 58.7±9.5 years. EF≤35% was present in 1342 (9.1%) of patients. In-hospital mortality was significantly increased univariate in EF≤35%, while this association diminished after confounders were adjusted for by using the propensity score (p=0.242). Following adjustment it was demonstrated that renal failure, cardiac arrest, heart block, infectious complication, total ventilation time, and total ICU hours were more frequent in patients with EF≤35%. CONCLUSION: We demonstrated EF≤35% was not predictor of in-hospital mortality in patients underwent CABG. Careful preoperative patient selection remains essential in patients with EF≤35% undergoing CABG.

Comparison of compression stocking with elastic bandage in reducing postoperative edema in coronary artery bypass graft patient.

The removal of the saphenous veins in coronary artery bypass graft (CABG) surgery may cause leg edema. Compression therapy is often used to prevent postoperative edema. The objective of this study was to compare the efficacy of medical compression stocking (TED) and elastic bandage-type on donor limbs after CABG. The peripheries of lower limbs were measured at four regions (A: end of tarsal bones, H: heel , B: immediately above the ankle, C: largest circumference of the calf) at admission in 295 patients how CABG candidates and differences in these measurement points at discharge compared to measurements at admission time were calculated. The difference was considered as a measure of the effectiveness of two types of compression to prevent postoperative edema in donor limbs after CABG. The alterations of 396 donor limbs of 295 patients were examined after CABG at admission and discharge time. In 101 patients veins for graft were taken from both lower limbs. After analysis, if subjects had worn TED stockings, the peripheries of donor limbs at discharge were less than at admission time in the A and H regions compared to elastic bandage group (P(A) = 0/009), (P(H) = 0/012). The conclusion reached was that using the kind of knee length compression stocking (TED stocking , Kendall Co.) is more effective edema at foot and heel regions in donor limbs after CABG than elastic bandages.

Traditional cardiac risk factors profile in Iranian patients undergoing coronary artery bypass surgery.

OBJECTIVE: It is well known that the traditional cardiac risk factors (TCRFs) affect short-term and long-term outcome following coronary artery bypass graft surgery (CABG). The objective of this study was to detect the prevalence of these risk factors i.e., hypertension, diabetes mellitus, hyperlipidaemia, smoking and family history of premature CAD in an Iranian population undergoing coronary artery bypass surgery. METHODS AND RESULTS: From March 2001 to September 2005, we retrospectively analysed prospectively collected data from our registry. Data were achieved regarding TCRFs in 10,622 consecutive patients undergoing elective CABG. Mean age of the patients was 58.75 +/- 9.72 years and 74.4% were men. The majority of the patients were overweight with a body mass index (BMI) > or = 25.0 kg/m2. Hyperlipidaemia was present in 63.9% of the patients. Over half of all the patients had hypertension and over one third diabetes. History of smoking was present in 37.7% of the patients and one third had a family history of CAD. Of all the patients, 91.6% had at least one of the TCRFs. As compared to men, women were more overweight or obese, and had a greater prevalence of hyperlipidaemia, hypertension, diabetes mellitus, and family history of CAD but smoking was much more common in men than in women. CONCLUSION: The current study revealed a high prevalence of most of TCRFs in an Iranian population that underwent CABG.

Determinant factors of renal failure after coronary artery bypass grafting with on-pump technique.

OBJECTIVE: The aim of the present study was to investigate the determinant factors of acute renal failure (ARF) after isolated on-pump coronary artery bypass grafting (CABG). SUBJECTS AND METHODS: This was a retrospective study of 13,315 adult patients who underwent isolated CABG with cardiopulmonary bypass (CPB) in Tehran Heart Center from May 2002 to May 2007. The exclusion criteria were age <18, concomitant cardiac and/or noncardiac surgical operations, history of renal failure before surgery, and chronic renal failure requiring dialysis. Preoperative and operative variables were measured, and a multivariate logistic regression model was constructed to identify the independent risk factors for developing renal failure after on-pump CABG. RESULTS: Of the 13,315 patients, 3,347 (25.4%) and 90,883 (74.6%) were females and males, respectively, with a mean age of 58.63 +/- 9.48 years. ARF was detected in 85 (0.6%) of the patients with isolated on-pump CABG. The mean age of the patients was 58.63 +/- 9.48 years, and 25.5% of them were female. The multivariate logistic regression analysis identified age (OR = 1.035; p = 0.002), female gender (OR = 1.622; p = 0.037), history of peripheral vascular disease (PVD) (OR = 2.579; p = 0.042), diabetes mellitus (OR = 1.918; p < 0.001), emergent and urgent surgery (OR = 1.744 and OR = 7.901, respectively; p = 0.003), CPB time >70 min (OR = 1.944; p = 0.007), and intra-aortic balloon pump (IABP) insertion (OR = 10.181; p < 0.001) as the independent risk factors for ARF. CONCLUSION: The data showed that age, female gender, positive history of diabetes and PVD, urgent and emergent surgery, CPB time >70 min, and need for IABP were the independent determinant factors of ARF after on-pump CABG.