title: Early surgery after angiography in patients scheduled for valve replacement.
abstract: 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.
authors.affiliation: National Institute of Cardiac Surgery, Montevideo, Uruguay.
authors.forename: Victor
authors.initials: V
authors.lastname: Dayan
authors.affiliation: National Institute of Cardiac Surgery, Montevideo, Uruguay.
authors.forename: Roberto
authors.initials: R
authors.lastname: Stanham
authors.affiliation: National Institute of Cardiac Surgery, Montevideo, Uruguay.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Soca
authors.affiliation: National Institute of Cardiac Surgery, Montevideo, Uruguay.
authors.forename: Fernando
authors.initials: F
authors.lastname: Genta
authors.affiliation: National Institute of Cardiac Surgery, Montevideo, Uruguay.
authors.forename: Jorge
authors.initials: J
authors.lastname: Mariño
authors.affiliation: National Institute of Cardiac Surgery, Montevideo, Uruguay.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Lorenzo
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D018579:Patient Selection; D011237:Predictive Value of Tests; D051437:Renal Insufficiency / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: Acute kidney injury; Contrast media; Coronary angiography; Creatinine; Heart valve diseases; Heart valve prosthesis implantation