title: Acute kidney injury following surgical aortic valve replacement.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a significant complication of surgical aortic valve replacement (SAVR). This study sought to describe AKI following SAVR, its risk factors, predictors and effect on long-term survival.
  
  
  METHODS
  We retrospectively reviewed 2169 patients who underwent isolated SAVR between 2000 and 2012. The main end-points were occurrence of AKI, postoperative complications, and short- and long-term survival rates following SAVR. Patients were divided into two groups: AKI+ (n = 181) and AKI- (n = 1945).
  
  
  RESULTS
  AKI occurred in 8.5% of patients, of which 3.9% (n = 7) needed dialysis. Predictors of AKI after SAVR were body mass index (BMI) and intraoperative packed red blood cells (PRBC) transfusion. AKI+ patients had a more complicated postoperative course and higher cumulative mortality (25% vs. 17%, p = 0.012) with a median follow-up of 4.1 years. AKI was not found to be an independent predictor of mortality.
  
  
  CONCLUSIONS
  Predictors of AKI after SAVR are increased BMI and intraoperative PRBC transfusion. AKI conferred an increase in hospital length of stay and cumulative mortality while the need for postoperative dialysis was associated with the most complicated hospital stays and the highest in-hospital and cumulative mortalities; therefore careful recognition of patients at risk of AKI is warranted for a better preoperative renal optimization. However, incidence of AKI was lower than what is reported after both on-CPB cardiac surgeries and transcatheter aortic valve replacement, moreover AKI was not found to be an independent predictor of mortality.
authors.affiliation: New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York.
authors.forename: Marc
authors.initials: M
authors.lastname: Najjar
authors.affiliation: New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York.
authors.forename: Halit
authors.initials: H
authors.lastname: Yerebakan
authors.affiliation: New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Sorabella
authors.affiliation: New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York.
authors.forename: Denis J
authors.initials: DJ
authors.lastname: Donovan
authors.affiliation: New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York.
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Kossar
authors.affiliation: New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York.
authors.forename: Sowmyashree
authors.initials: S
authors.lastname: Sreekanth
authors.affiliation: New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York.
authors.forename: Paul
authors.initials: P
authors.lastname: Kurlansky
authors.affiliation: New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.affiliation: New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Argenziano
authors.affiliation: New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Smith
authors.affiliation: New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York.
authors.forename: Isaac
authors.initials: I
authors.lastname: George
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D015992:Body Mass Index; D003956:Dialysis; D017707:Erythrocyte Transfusion; D005260:Female; D005544:Forecasting; D006330:Heart Defects, Congenital / Q000601:surgery*; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate