Giovanni Mariscalco1, Marzia Cottini2, Carmelo Dominici3, Maciej Banach4, Gabriele Piffaretti5, Paolo Borsani3, Vito Domenico Bruno6, Claudio Corazzari2, Riccardo Gherli2, Cesare Beghi2. 1. Department of Heart and Vessels, Cardiac Surgery Unit, Varese University Hospital, Varese, Italy. Electronic address: giovannimariscalco@yahoo.it. 2. Department of Surgical and Morphological Sciences, Cardiac Surgery Unit, Varese University Hospital, University of Insubria, Varese, Italy. 3. Department of Heart and Vessels, Cardiac Surgery Unit, Varese University Hospital, Varese, Italy. 4. Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland. 5. Department of Heart and Vessels, Vascular Surgery Unit, Varese University Hospital, Italy. 6. Department of Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland.
Abstract
BACKGROUND: Acute kidney injury (AKI) is a vexing complication of cardiac surgery. Since exposure to contrast agents is a relevant contributing factor in the development of postoperative AKI, the optimal timing between cardiac catheterization and surgery is decisive. METHODS: A total of 2504 consecutive nonemergent patients undergoing isolated coronary artery bypass grafting (CABG), valve surgery (with or without concomitant CABG), and proximal aortic procedures were enrolled. AKI was defined by consensus RIFLE (Risk, Injury, Failure, Loss of function, End-stage renal disease) criteria. The association of postoperative AKI and time between cardiac catheterization and operation was evaluated using multivariable logistic regression modeling and propensity-matched analysis. RESULTS: Postoperative AKI occurred in 230 (9%) patients. The median number of days from cardiac catheterization to operation was 5 (25th to 75th percentile: 2 to 10). The incidence of AKI was significantly higher in patients operated on ≤1 day after cardiac catheterization compared to those operated on >1 day after (13% vs. 8%, p=0.004). The time interval between cardiac catheterization and surgery (tested both as a continuous and a categorical variable) was not an independent AKI predictor in the propensity-matched population or the pre-matched one. Contrast exposure≤1 day before surgery was independently associated with postoperative AKI in patients undergoing valve surgery with concomitant CABG only (post-matched: OR 3.68, 95%CI 1.30 to 10.39, p=0.014). CONCLUSIONS: Delaying cardiac surgery beyond 24h of exposure to contrast agents seems to be justified only in patients undergoing valve surgery with concomitant CABG.
BACKGROUND:Acute kidney injury (AKI) is a vexing complication of cardiac surgery. Since exposure to contrast agents is a relevant contributing factor in the development of postoperative AKI, the optimal timing between cardiac catheterization and surgery is decisive. METHODS: A total of 2504 consecutive nonemergent patients undergoing isolated coronary artery bypass grafting (CABG), valve surgery (with or without concomitant CABG), and proximal aortic procedures were enrolled. AKI was defined by consensus RIFLE (Risk, Injury, Failure, Loss of function, End-stage renal disease) criteria. The association of postoperative AKI and time between cardiac catheterization and operation was evaluated using multivariable logistic regression modeling and propensity-matched analysis. RESULTS: Postoperative AKI occurred in 230 (9%) patients. The median number of days from cardiac catheterization to operation was 5 (25th to 75th percentile: 2 to 10). The incidence of AKI was significantly higher in patients operated on ≤1 day after cardiac catheterization compared to those operated on >1 day after (13% vs. 8%, p=0.004). The time interval between cardiac catheterization and surgery (tested both as a continuous and a categorical variable) was not an independent AKI predictor in the propensity-matched population or the pre-matched one. Contrast exposure≤1 day before surgery was independently associated with postoperative AKI in patients undergoing valve surgery with concomitant CABG only (post-matched: OR 3.68, 95%CI 1.30 to 10.39, p=0.014). CONCLUSIONS: Delaying cardiac surgery beyond 24h of exposure to contrast agents seems to be justified only in patients undergoing valve surgery with concomitant CABG.
Authors: Marc Najjar; Halit Yerebakan; Robert A Sorabella; Denis J Donovan; Alexander P Kossar; Sowmyashree Sreekanth; Paul Kurlansky; Michael A Borger; Michael Argenziano; Craig R Smith; Isaac George Journal: J Card Surg Date: 2015-06-24 Impact factor: 1.620
Authors: Lekha K George; Miklos Z Molnar; Jun L Lu; Kamyar Kalantar-Zadeh; Santhosh K G Koshy; Csaba P Kovesdy Journal: Sci Rep Date: 2015-11-09 Impact factor: 4.379