Does the preoperative mild renal dysfunction effect mortality and morbidity following valve cardiac surgery?

Aljadayel, Hadi Abo; Alkanj, Hussein; Koja, Salah; Butruss, Fadi

doi:10.1016/j.ihj.2015.07.044

Cited by 3 publications

(2 citation statements)

References 13 publications

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“…Therefore, finding the risk factors related to mortality associated with cardiac surgery can help to stratify patients. Previous studies have reported that preoperative renal dysfunction is significantly and independently associated with mortality after cardiac surgery (8)(9)(10). However, limited by methodology and samples, studies with larger sample sizes are needed to clarify the true relationship between preoperative Ccr and postoperative in-hospital mortality.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Creatinine Clearance and Mortality of Elective Cardiac Surgery in Hospitalization: A Secondary Analysis

Chen

Song

Qian

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveIt has been reported that poor renal function before surgery is related to poor prognosis. However, there is no specific discussion on the ideal value of preoperative creatinine clearance. Consequently, our primary goal is to explore the correlation between baseline creatinine clearance and short-term mortality after cardiac surgery.MethodsWe conducted a secondary data analysis based on a French cardiac surgery cohort. The cohort included 6,889 participants in a Paris university hospital from December 2005 to December 2012. The exposure variable and outcome variable used in this secondary analysis were the preoperative creatinine clearance rate and postoperative hospital mortality. Multivariate logistic regression and generalized additive models were employed.ResultsThe nonlinear relationship between the preoperative creatinine clearance rate and postoperative death was observed in this study. The preoperative creatinine clearance rate was negatively correlated with postoperative mortality in the range of 8.9–78.5 in patients younger than 80 years old (odds ratio = 0.98, 95% confidence interval 0.97–0.98, in Cockcroft Gault formulae). However, this effect characteristics reaches saturation after the preoperative creatinine clearance rate exceeds 78.5 (odds ratio = 0.99, 95% confidence interval 0.98–1.00, CG). In patients with history of thromboembolic event and coronary artery disease, the saturation effect were 30.8 mL.min−1 (CG) and 56.6 mL.min−1(CG).ConclusionIn the range of 8.9–78.5 (Cockcroft), an increase in preoperative creatinine clearance is associated with a decrease in postoperative mortality with patients younger than 80 years old. In patients with a history of embolism and coronary artery disease, the cut-off points of the reduction in preoperative creatinine clearance associated with a increase in postoperative mortality are 30.8 mL.min−1 and 56.6 mL.min−1.

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Section: Introductionmentioning

confidence: 99%

Preoperative Creatinine Clearance and Mortality of Elective Cardiac Surgery in Hospitalization: A Secondary Analysis

Chen

Song

Qian

et al. 2022

Front. Cardiovasc. Med.

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“… 6 Aljadayel et al studied 340 patients who underwent cardiac valve surgery and found that 80 patients (30%) had preoperative mild RD, with the glomerular filtration rate estimated to be <60 mL/min/1.73 m 2 , and this preoperative mild RD is an independent marker of postoperative morbidity (more red blood cell transfusions, reoperation, and longer hospital stay). 7 With age and increasing preoperative comorbidities including diabetes, hypertension, and peripheral angiopathy, the proportion of RD also increased, with the prevalence being ≥20%. 8 However, the pathophysiology of preoperative RD in patients who undergo cardiac surgery is quite unique.…”

Section: Introductionmentioning

confidence: 99%

Reversible preoperative renal dysfunction does not add to the risk of postoperative acute kidney injury after cardiac valve surgery

Zhuang

Liu

et al. 2017

TCRM

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ObjectiveTo evaluate the impact of the renal dysfunction (RD) type and change of postoperative cardiac function on the risk of developing acute kidney injury (AKI) in patients who underwent cardiac valve surgery.MethodReversible renal dysfunction (RRD) was defined as preoperative RD in patients who had not been initially diagnosed with chronic kidney disease (CKD). Cardiac function improvement (CFI) was defined as postoperative left ventricular ejection function – preoperative left ventricular ejection function (ΔEF) >0%, and cardiac function not improved (CFNI) as ΔEF ≤0%.ResultsOf the 4,805 (94%) cardiac valve surgery patients, 301 (6%) were RD cases. The AKI incidence in the RRD group (n=252) was significantly lower than in the CKD group (n=49) (36.5% vs 63.3%, P=0.018). The AKI and renal replacement therapy incidences in the CFI group (n=174) were significantly lower than in the CFNI group (n=127) (33.9% vs 50.4%, P=0.004; 6.3% vs 13.4%, P=0.037). After adjustment for age, gender, and other confounding factors, CKD and CKD + CFNI were identified as independent risk factors for AKI in all patients after cardiac valve surgery. Multivariate logistic regression analysis showed that the risk factors for postoperative AKI in preoperative RD patients were age, gender (male), hypertension, diabetes, chronic heart failure, cardiopulmonary bypass time (every 1 min added), and intraoperative hypotension, while CFI after surgery could reduce the risk.ConclusionFor cardiac valve surgery patients, preoperative CKD was an independent risk factor for postoperative AKI, but RRD did not add to the risk. Improved postoperative cardiac function can significantly reduce the risk of postoperative AKI.

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Circulating extracellular vesicles from patients with valvular heart disease induce neutrophil chemotaxis via FOXO3a and the inhibiting role of dexmedetomidine

Yuan

Chen

et al. 2020

American Journal of Physiology-Endocrinology and Metabolism

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We previously demonstrated that circulating extracellular vesicles (EVs) from patients with valvular heart disease (VHD; vEVs) contain inflammatory components and inhibit endothelium-dependent vasodilation. Neutrophil chemotaxis plays a key role in renal dysfunction, and dexmedetomidine (DEX) can reduce renal dysfunction in cardiac surgery. However, the roles of vEVs in neutrophil chemotaxis and effects of DEX on vEVs are unknown. Here, we investigated the impact of vEVs on neutrophil chemotaxis in kidneys and the influence of DEX on vEVs. Circulating EVs were isolated from healthy subjects and patients with VHD. The effects of EVs on chemokine generation, forkhead box protein O3a (FOXO3a) pathway activation and neutrophil chemotaxis on cultured human umbilical vein endothelial cells (HUVECs) and kidneys in mice and the influence of DEX on EVs were detected. vEVs increased FOXO3a expression, decreased phosphorylation of Akt and FOXO3a, promoted FOXO3a nuclear translocation, and activated the FOXO3a signaling pathway in vitro. DEX pretreatment reduced vEV-induced CXCL4 and CCL5 expression and neutrophil chemotaxis in cultured HUVECs via the FOXO3a signaling pathway. vEVs were also found to suppress Akt phosphorylation and activate FOXO3a signaling to increase plasma levels of CXCL4 and CCL5 and neutrophil accumulation in kidney. The overall mechanism was inhibited in vivo with DEX pretreatment. Our data demonstrated that vEVs induced CXCL4-CCL5 to stimulate neutrophil infiltration in kidney, which can be inhibited by DEX via the FOXO3a signaling. Our findings reveal a unique mechanism involving vEVs in inducing neutrophils chemotaxis and may provide a novel basis for using DEX in reducing renal dysfunction in valvular heart surgery.

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Does the preoperative mild renal dysfunction effect mortality and morbidity following valve cardiac surgery?

Cited by 3 publications

References 13 publications

Preoperative Creatinine Clearance and Mortality of Elective Cardiac Surgery in Hospitalization: A Secondary Analysis

Preoperative Creatinine Clearance and Mortality of Elective Cardiac Surgery in Hospitalization: A Secondary Analysis

Reversible preoperative renal dysfunction does not add to the risk of postoperative acute kidney injury after cardiac valve surgery

Circulating extracellular vesicles from patients with valvular heart disease induce neutrophil chemotaxis via FOXO3a and the inhibiting role of dexmedetomidine

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