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Ann Thorac Surg 2003;75:1829-1835
© 2003 The Society of Thoracic Surgeons

Original article: cardiovascular

Valvular heart operation is an independent risk factor for acute renal failure

Antony D. Graysona*, Magdy Khater, FRCAb, Mark Jackson, PhDa, Mark A. Fox, FRCAb

a Department of Research and Development, Liverpool, United Kingdom
b Department of Cardiothoracic Anaesthesia, The Cardiothoracic Centre, Liverpool, United Kingdom

Accepted for publication January 16, 2003.

* Address reprint requests to Mr Grayson, Regional Clinical Information Analyst, The Cardiothoracic Centre-Liverpool, Thomas Drive, LiverpoolL14 3PE United Kingdom.
e-mail: tony.grayson{at}ctc.nhs.uk

BACKGROUND: Acute renal failure (ARF) after cardiac operation with cardiopulmonary bypass is associated with a high mortality rate. The purpose of this study was to determine and quantify whether valvular heart operation is an independent risk factor for developing ARF.

METHODS: We retrospectively analyzed 5,132 consecutive patients who underwent cardiac operation involving cardiopulmonary bypass between April 1997 and March 2001. Patients with significant renal impairment (preoperative serum creatinine > 200 µmol/L) were excluded. A multivariable logistic regression model was constructed to identify independent risk factors for the postoperative development of ARF.

RESULTS: In 151 (2.9%) patients ARF developed before hospital discharge. The crude incidence of ARF for isolated coronary artery bypass grafting, isolated valve(s) operation, and valve(s) with coronary artery bypass grafting operation was 1.9%, 4.4%, and 7.5%, respectively (p < 0.001). The results of the logistic regression analysis found that valve operation with or without coronary artery bypass grafting was an independent risk factor for the development of postoperative ARF (odds ratio 2.68, 95% confidence interval 1.89 to 3.79; p < 0.001). Other independent predictors of ARF were increased preoperative serum creatinine levels, urgent or emergent operation, insulin-dependent diabetes, and increased cardiopulmonary bypass time.

CONCLUSIONS: Valve operation is an independent risk factor for postoperative ARF. This risk is further increased by prolonged cardiopulmonary bypass.




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