title: Correlation of Preoperative Renal Insufficiency With Mortality and Morbidity After Aortic Valve Replacement: A Propensity Score Matching Analysis.
abstract: Preoperative end-stage renal disease carries a high mortality and morbidity risk after aortic valve replacement (AVR), but the effect of renal insufficiency remains to be clarified. Through propensity score analysis, we compared the preoperative demographics, perioperative profiles, and outcomes between patients with and without renal insufficiency. From August 2005 to November 2014, 770 adult patients underwent AVR in a single institution. Patients were classified according to their estimated glomerular infiltration rate (eGFR) as renal insufficiency (eGFR: 30-89 mL/min/1.73 m) or normal (eGFR, ≥90 mL/min/1.73 m). Propensity scoring was performed with a 1:1 ratio, resulting in a matched cohort of 88 patients per group. Demographics, comorbidities, and surgical procedures were well balanced between the 2 groups, except for diabetes mellitus and eGFR. Patients with renal insufficiency had higher in-hospital mortality (19.3% versus 3.4%, P < 0.001), a greater need for postoperative hemodialysis (14.8% versus 3.1%, P = 0.009), and prolonged intubation times (>72 hour; 25% versus 9.1%, P = .008), intensive care unit stays (8.9 ± 9.9 versus 4.9 ± 7.5 days, P = .046), and hospital stays (35.3 ± 31.7 versus 24.1 ± 20.3 days, P = .008), compared with those with normal renal function. Multivariate analysis confirmed that preoperative renal insufficiency was an in-hospital mortality predictor (odds ratio, 2.33; 95% confidence interval, 1.343-4.043; P = .003), as were prolonged cardiopulmonary bypass time, intraaortic balloon pump support, and postoperative hemodialysis. The 1-year survival significantly differed between the 2 groups including (normal 87.5% versus renal insufficiency 67.9%, P < .001) or excluding in-hospital mortality (normal 90.7% versus renal insufficiency 82.1%, P = .05). Patients with preoperative renal insufficiency who underwent AVR had higher in-hospital mortality rates and increased morbidities, especially those associated with hemodynamic instabilities requiring intraaortic balloon pump support or hemodialysis. Earlier surgical intervention for severe aortic valve disease should be considered in patients who show deteriorating renal function during follow-up.
authors.affiliation: From the Department of Cardiothoracic and Vascular Surgery Chang Gung Memorial Hospital (C-YL, F-CT, H-AL, S-WC, K-SL, P-JL), and Department of Nephrology, Chang Gung University College of Medicine, Taoyuan, Taiwan (Y-CC).
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Lin
authors.forename: Feng-Chun
authors.initials: FC
authors.lastname: Tsai
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Chen
authors.forename: Hsiu-An
authors.initials: HA
authors.lastname: Lee
authors.forename: Shao-Wei
authors.initials: SW
authors.lastname: Chen
authors.forename: Kuo-Sheng
authors.initials: KS
authors.lastname: Liu
authors.forename: Pyng-Jing
authors.initials: PJ
authors.lastname: Lin
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D015897:Comorbidity; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000379:methods / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D007677:Kidney Function Tests; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods / Q000706:statistics & numerical data; D057216:Propensity Score; D006435:Renal Dialysis / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology