Increased risk of acute kidney injury in patients undergoing tricuspid valve surgery

Lars Englberger, Rakesh M. Suri, Heidi M. Connolly, Zhuo Li, Martin D. Abel, Kevin L. Greason, Joseph A. Dearani, Hartzell V Schaff

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Objectives: We aimed to determine which patients undergoing tricuspid valve (TV) surgery are at increased risk for acute kidney injury (AKI). Methods: We reviewed 951 patients [mean age 67 ± 13 years, 573 (60%) female] having TV surgery between 2000 and 2007. Analysis focused on clinical outcome; AKI was defined by the consensus RIFLE criteria (risk, injury, failure). Results: Surgical procedures included isolated TV surgery in 224 (24%) and TV surgery in conjunction with another cardiac operation in 727 (76%) patients. TV surgery involved redo surgery in 395 (42%). The incidence of postoperative AKI was 30% (n = 285), and 75 (7.9%) of these patients required renal replacement therapy. AKI stratified by increased RIFLE class was associated with worse postoperative outcomes (prolonged intubation, length of hospital stay and mortality; P < 0.001 for each variable). For patients with AKI, odds ratio for mortality was 4.2 [95% confidence interval (CI) 3.2-5.4, P < 0.001; area under receiver operating curves 0.85 (95% CI 0.80-0.91)], and 2.3 (95% CI 1.9-2.9, P < 0.001) for prolonged intubation for each increase in RIFLE class. Independent risk factors for AKI were older age, male gender, previous surgery, preoperative anaemia, length of cardiopulmonary bypass and TV replacement. Importantly, preoperative creatinine and pulmonary artery pressure were not independently associated with AKI. Conclusions: TV surgery carries a high incidence of postoperative AKI that is associated with adverse outcome. The use of the RIFLE criteria allows comparison with prior studies and is an important predictor of early mortality. The estimation of patient risk for AKI should be based on multivariable prediction.

Original languageEnglish (US)
Article numberezs515
Pages (from-to)993-999
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume43
Issue number5
DOIs
StatePublished - May 2013

Fingerprint

Tricuspid Valve
Acute Kidney Injury
Confidence Intervals
Intubation
Length of Stay
Renal Replacement Therapy
Mortality
Incidence
Hospital Mortality
Cardiopulmonary Bypass
Pulmonary Artery
Anemia
Creatinine
Odds Ratio
Pressure
Wounds and Injuries

Keywords

  • Cardiac surgery
  • Cardio-renal syndrome
  • Heart failure
  • Right ventricular failure
  • Tricuspid valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Increased risk of acute kidney injury in patients undergoing tricuspid valve surgery. / Englberger, Lars; Suri, Rakesh M.; Connolly, Heidi M.; Li, Zhuo; Abel, Martin D.; Greason, Kevin L.; Dearani, Joseph A.; Schaff, Hartzell V.

In: European Journal of Cardio-thoracic Surgery, Vol. 43, No. 5, ezs515, 05.2013, p. 993-999.

Research output: Contribution to journalArticle

Englberger, L, Suri, RM, Connolly, HM, Li, Z, Abel, MD, Greason, KL, Dearani, JA & Schaff, HV 2013, 'Increased risk of acute kidney injury in patients undergoing tricuspid valve surgery', European Journal of Cardio-thoracic Surgery, vol. 43, no. 5, ezs515, pp. 993-999. https://doi.org/10.1093/ejcts/ezs515
Englberger, Lars ; Suri, Rakesh M. ; Connolly, Heidi M. ; Li, Zhuo ; Abel, Martin D. ; Greason, Kevin L. ; Dearani, Joseph A. ; Schaff, Hartzell V. / Increased risk of acute kidney injury in patients undergoing tricuspid valve surgery. In: European Journal of Cardio-thoracic Surgery. 2013 ; Vol. 43, No. 5. pp. 993-999.
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abstract = "Objectives: We aimed to determine which patients undergoing tricuspid valve (TV) surgery are at increased risk for acute kidney injury (AKI). Methods: We reviewed 951 patients [mean age 67 ± 13 years, 573 (60{\%}) female] having TV surgery between 2000 and 2007. Analysis focused on clinical outcome; AKI was defined by the consensus RIFLE criteria (risk, injury, failure). Results: Surgical procedures included isolated TV surgery in 224 (24{\%}) and TV surgery in conjunction with another cardiac operation in 727 (76{\%}) patients. TV surgery involved redo surgery in 395 (42{\%}). The incidence of postoperative AKI was 30{\%} (n = 285), and 75 (7.9{\%}) of these patients required renal replacement therapy. AKI stratified by increased RIFLE class was associated with worse postoperative outcomes (prolonged intubation, length of hospital stay and mortality; P < 0.001 for each variable). For patients with AKI, odds ratio for mortality was 4.2 [95{\%} confidence interval (CI) 3.2-5.4, P < 0.001; area under receiver operating curves 0.85 (95{\%} CI 0.80-0.91)], and 2.3 (95{\%} CI 1.9-2.9, P < 0.001) for prolonged intubation for each increase in RIFLE class. Independent risk factors for AKI were older age, male gender, previous surgery, preoperative anaemia, length of cardiopulmonary bypass and TV replacement. Importantly, preoperative creatinine and pulmonary artery pressure were not independently associated with AKI. Conclusions: TV surgery carries a high incidence of postoperative AKI that is associated with adverse outcome. The use of the RIFLE criteria allows comparison with prior studies and is an important predictor of early mortality. The estimation of patient risk for AKI should be based on multivariable prediction.",
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AU - Suri, Rakesh M.

AU - Connolly, Heidi M.

AU - Li, Zhuo

AU - Abel, Martin D.

AU - Greason, Kevin L.

AU - Dearani, Joseph A.

AU - Schaff, Hartzell V

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AB - Objectives: We aimed to determine which patients undergoing tricuspid valve (TV) surgery are at increased risk for acute kidney injury (AKI). Methods: We reviewed 951 patients [mean age 67 ± 13 years, 573 (60%) female] having TV surgery between 2000 and 2007. Analysis focused on clinical outcome; AKI was defined by the consensus RIFLE criteria (risk, injury, failure). Results: Surgical procedures included isolated TV surgery in 224 (24%) and TV surgery in conjunction with another cardiac operation in 727 (76%) patients. TV surgery involved redo surgery in 395 (42%). The incidence of postoperative AKI was 30% (n = 285), and 75 (7.9%) of these patients required renal replacement therapy. AKI stratified by increased RIFLE class was associated with worse postoperative outcomes (prolonged intubation, length of hospital stay and mortality; P < 0.001 for each variable). For patients with AKI, odds ratio for mortality was 4.2 [95% confidence interval (CI) 3.2-5.4, P < 0.001; area under receiver operating curves 0.85 (95% CI 0.80-0.91)], and 2.3 (95% CI 1.9-2.9, P < 0.001) for prolonged intubation for each increase in RIFLE class. Independent risk factors for AKI were older age, male gender, previous surgery, preoperative anaemia, length of cardiopulmonary bypass and TV replacement. Importantly, preoperative creatinine and pulmonary artery pressure were not independently associated with AKI. Conclusions: TV surgery carries a high incidence of postoperative AKI that is associated with adverse outcome. The use of the RIFLE criteria allows comparison with prior studies and is an important predictor of early mortality. The estimation of patient risk for AKI should be based on multivariable prediction.

KW - Cardiac surgery

KW - Cardio-renal syndrome

KW - Heart failure

KW - Right ventricular failure

KW - Tricuspid valve replacement

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