Atherosclerosis of the ascending aorta is a predictor of renal dysfunction after cardiac operations.
OBJECTIVE
Renal dysfunction occurring after cardiac operations has been attributed to various factors, but the importance of an atherosclerotic thoracic aorta has not been previously evaluated. The purpose of this study was to identify predictors of postoperative renal dysfunction (50% or more increase from preoperative values) and to evaluate the importance of atherosclerosis of the ascending aorta as a predictor of this complication.


METHODS
Nine hundred seventy-eight consecutive patients, 50 years of age and older with normal preoperative renal function (serum creatinine level of 1.5 mg/dL or less), who were scheduled to undergo cardiac surgery were prospectively evaluated. Atherosclerosis of the ascending aorta was assessed during the operation (with epiaortic ultrasound), and patients were divided into 3 groups according to its severity (normal-to-mild, moderate, and severe).


RESULTS
Univariate predictors of renal dysfunction at postoperative day 1 were atherosclerosis of the ascending aorta (P <. 045) and postoperative low cardiac output (P =.05); at postoperative day 6 they were atherosclerosis of the ascending aorta (P <.0001), postoperative low cardiac output (P <.0001), advanced age (P =.001), decreased preoperative left ventricular function (P =.01), and female gender (P =.03). Multivariate analysis showed that atherosclerosis of the ascending aorta (odds ratio, 3.06; P =.04) was the only independent predictor of postoperative renal dysfunction at day 1 and that postoperative low cardiac output (odds ratio, 4.83; P <.0001), atherosclerosis of the ascending aorta (odds ratio, 2.13; P =.0006), and preoperative left ventricular dysfunction (odds ratio, 1.48; P =.028) were independent predictors of postoperative renal dysfunction at day 6.


CONCLUSIONS
An atherosclerotic ascending aorta is an important predictor of postoperative renal dysfunction, possibly because atheroembolism to the kidneys occurs in the perioperative period (ie, during surgical manipulation of an atherosclerotic aorta) or because the diseased aorta may be a marker of widespread atherosclerotic disease that may predispose to perioperative renal dysfunction.
Dávila-Román
V G
VG
Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
Kouchoukos
N T
NT
Schechtman
K B
KB
Barzilai
B
B
D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000150:complications* / Q000503:physiopathology; D001161:Arteriosclerosis / Q000150:complications* / Q000503:physiopathology; D002302:Cardiac Output; D001026:Coronary Artery Bypass; D003404:Creatinine / Q000097:blood; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D016277:Ventricular Function, Left
D003404:Creatinine