Risk Analysis and Outcomes of Postoperative Renal Failure After Aortic Valve Surgery in the United States.

MedStar author(s):
Citation: Annals of Thoracic Surgery. 109(4):1133-1141, 2020 04.PMID: 31494138Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Aortic Valve/su [Surgery] | *Heart Valve Diseases/su [Surgery] | *Heart Valve Prosthesis Implantation/ae [Adverse Effects] | *Postoperative Complications/ep [Epidemiology] | *Renal Insufficiency/ep [Epidemiology] | *Risk Assessment/mt [Methods] | Aged | Disease Progression | Female | Follow-Up Studies | Glomerular Filtration Rate/ph [Physiology] | Humans | Incidence | Male | Postoperative Complications/et [Etiology] | Postoperative Complications/th [Therapy] | Renal Dialysis | Renal Insufficiency/et [Etiology] | Renal Insufficiency/th [Therapy] | Retrospective Studies | Risk Factors | Survival Rate/td [Trends] | Time Factors | United States/ep [Epidemiology]Year: 2020Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:
  • 0003-4975
Name of journal: The Annals of thoracic surgeryAbstract: 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.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. Copyright (c) 2019. Published by Elsevier Inc.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).All authors: Badhwar V, Polo MC, Shemin RJ, Thibault D, Thourani VH, Xian YOriginally published: Annals of Thoracic Surgery. 2019 Sep 05Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2019-10-10
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 31494138 Available 31494138

Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007

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.

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. Copyright (c) 2019. Published by Elsevier Inc.

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).

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