Early surgery after angiography in patients scheduled for valve replacement

• Published in: Asian cardiovascular & thoracic annals 2017-01, Vol.25 (1), p.18-23
• Main Authors: Dayan, Victor, Stanham, Roberto, Soca, Gerardo, Genta, Fernando, Mariño, Jorge, Lorenzo, Alvaro
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - blood; Acute Kidney Injury - etiology; Aged; Aged, 80 and over; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Biomarkers - blood; Coronary Angiography - adverse effects; Creatinine - blood; Female; Heart Valve Diseases - complications; Heart Valve Diseases - diagnostic imaging; Heart Valve Diseases - mortality; Heart Valve Diseases - surgery; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - mortality; Hospital Mortality; Humans; Male; Middle Aged; Mitral Valve - diagnostic imaging; Mitral Valve - surgery; Patient Selection; Predictive Value of Tests; Renal Insufficiency - blood; Renal Insufficiency - complications; Renal Insufficiency - diagnosis; Renal Insufficiency - mortality; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Time-to-Treatment; Treatment Outcome
• ISSN: 0218-4923; 1816-5370
• DOI: 10.1177/0218492316680496

Background There are limited data regarding the risks of cardiac surgery early after coronary angiography in patients scheduled for isolated aortic and/or mitral valve replacement. Our aim was to evaluate the risk of early surgery after coronary angiography in these patients. Methods We retrospectively analyzed data of 1044 patients who underwent isolated aortic and/or mitral valve replacement from 2006 to 2014. Baseline, operative, and postoperative variables were collected. The patients were divided into 3 groups based on the interval between coronary angiography and surgery: ≤3 days (n = 216), 4–7 days (n = 109), and ≥8 days (n = 719). We evaluated hospital mortality and postoperative acute kidney injury. Subgroup analysis was performed according to preoperative creatinine clearance. Results Postoperative creatinine clearance was lower in patients who underwent surgery ≤3 days after coronary angiography (63.57 ± 38.52 mL min−1) compared to ≥8 days after coronary angiography (74.56 ± 54.25 mL min−1, p = 0.015). Patients who underwent surgery ≤3 days after coronary angiography had higher hospital mortality when preoperative creatinine clearance was ≤60 mL min−1 (12% vs. 4% for creatinine clearance ≤and >60 mL min−1, respectively; p = 0.039). Predictors of hospital mortality were New York Heart Association class and postoperative creatinine clearance. Conclusion Hospital mortality was higher in patients with decreased preoperative renal function who underwent surgery within the first 3 days after coronary angiography. Delaying surgery in this subgroup of patients could be a good strategy.