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Acute Kidney Injury Classification Underestimates Long-Term Mortality After Cardiac Valve Operations

Bouma, H. R., Mungroop, H. E., de Geus, A. F., Huisman, D. D., Nijsten, M. W. N., Mariani, M. A., Scheeren, T. W. L., Burgerhof, J. G. M., Henning, R. H. & Epema, A. H., Jul-2018, In : Annals of thoracic surgery. 106, 1, p. 92-98 7 p.

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  • Acute Kidney Injury Classification Underestimates Long-Term Mortality After Cardiac Valve Operations

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DOI

Background. Perioperative acute kidney injury (AKI) is an important predictor of long-term all-cause mortality after coronary artery bypass (CABG). However, the effect of AKI on long-term mortality after cardiac valve operations is hitherto undocumented.

Methods. Perioperative renal injury and long-term allcause mortality after valve operations were studied in a prospective cohort of patients undergoing solitary valve operations (n = 2,806) or valve operations combined with CABG (n = 1,260) with up to 18 years of follow-up. Postoperative serum creatinine increase was classified according to AKI staging 0 to 3. Patients undergoing solitary CABG (n = 4,938) with cardiopulmonary bypass served as reference.

Results. In both valve and valve+CABG operations, postoperative renal injury of AKI stage 1 or higher was progressively associated with an increase in long-term mortality (hazard ratio [HR], 2.27, p <0.05 for valve; HR, 1.65, p <0.05 for valve+CABG; HR, 1.56, p <0.05 for CABG). Notably, the mortality risk increased already substantially at serum creatinine increases of 10% to 25%-that is, far below the threshold for AKI stage 1 after valve operations (HR, 1.39, p <0.05), but not after valve operations combined with CABG or CABG only.

Conclusions. An increase in serum creatinine by more than 10% during the first week after valve operation is associated with an increased risk for long-term mortality after cardiac valve operation. Thus, AKI classification clearly underestimates long-term mortality risk in patients undergoing valve operations. (C) 2018 by The Society of Thoracic Surgeons

Original languageEnglish
Pages (from-to)92-98
Number of pages7
JournalAnnals of thoracic surgery
Volume106
Issue number1
Early online date1-Mar-2018
Publication statusPublished - Jul-2018

    Keywords

  • RANDOMIZED-CONTROLLED-TRIAL, MEASUREMENT TASK-FORCE, ACUTE-RENAL-FAILURE, COMPOSITE SCORE, CLINICAL-TRIAL, RISK-FACTORS, SURGERY, OUTCOMES, DISEASE, REPLACEMENT

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