Increased Short-Term and Mid-Term Major Complications Were Observed in Elderly Patients with Renal Dysfunction after Surgical Ventricular Restoration

Authors

  • Fei Xu Department of Cardiovascular Surgery, Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
  • Yangwu Song Department of Cardiovascular Surgery, Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
  • Wei Feng Department of Cardiovascular Surgery, Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
  • Xuan Li Department of Cardiovascular Surgery, Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
  • Junzhe Du Department of Cardiovascular Surgery, Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China

DOI:

https://doi.org/10.1532/hsf.1911

Keywords:

urgical ventricular restoration, renal dysfunction, elderly, complications

Abstract

Background: This study was conducted to explore the impact of renal dysfunction on short-term and mid-term outcomes in elderly patients.

Methods: Patients over 65 years of age receiving surgical ventricular restoration (SVR) were included in the study. They were stratified through estimated glomerular filtration rate (eGFR), with a cutoff point of 60 mL/min/1.73m2. Risk-adjusted analysis, including propensity score matching, was carried out to compare short-term and mid-term outcomes between the two groups of patients.

Results: From January 1999 to December 2015, a total of 280 elderly patients underwent SVR. Of the patients, 79 had eGFR lower than 60 mL/min/1.73m2 and were considered to have renal dysfunction. Mortality was higher in the renal dysfunction group than the normal renal function group, with marginal significance (adjusted P value = .06). The need for mechanical supports (adjusted P value = .04) was higher in the renal dysfunction group. Hemofiltration (adjusted
P value < .01) and requirements for transfusion (adjusted
P value = .03) were significantly higher in the renal dysfunction group than in the group with normal renal function. The presence of renal dysfunction was associated with higher risk of major adverse cerebro-cardiovascular events (MACCE) than normal renal function (HR = 2.34, 95% CI = 1.34 - 4.08, P = .003).

Conclusion: Compared to patients with normal renal function, elderly SVR patients with renal failure have a higher incidence of short-term mechanical support, mid-term mortality, and MACCE events.

References

Buckberg GD, Athanasuleas CL. 2009. The STICH trial: misguided conclusions. J Thorac Cardiovasc Surg 138:1060-4 e1062.

Buckberg GD, Athanasuleas CL, Wechsler AS, et al. 2010. The STICH trial unravelled. Eur J Heart Fail 12:1024-7.

Castelvecchio S, Parolari A, Garatti A, et al. 2016. Surgical ventricular restoration plus mitral valve repair in patients with ischaemic heart failure: risk factors for early and mid-term outcomes. Eur J Cardiothorac Surg 49:e72-8; discussion e78-9.

Dries DL, Exner DV, Domanski MJ, et al. 2000. The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. J Am Coll Cardiol 35:681-9.

Hernandez AF, Velazquez EJ, Dullum MK, et al. 2006. Contemporary performance of surgical ventricular restoration procedures: data from the Society of Thoracic Surgeons’ National Cardiac Database. Am Heart J 152:494-9.

Hu S, Zheng Z, Yuan X, et al. 2010. Increasing long-term major vascular events and resource consumption in patients receiving off-pump coronary artery bypass: a single-center prospective observational study. Circulation 121:1800-8.

Jessup M, Brozena S. Heart failure. 2003. N Engl J Med 348:2007-18.

Jones RH, Velazquez EJ, Michler RE, et al. 2009. Coronary bypass surgery with or without surgical ventricular reconstruction. N Engl J Med 360:1705-17.

Jong P, Vowinckel E, Liu PP, et al. 2002. Prognosis and determinants of survival in patients newly hospitalized for heart failure: a population-based study. Arch Intern Med 162:1689-94.

Levey AS, Bosch JP, Lewis JB, et al. 1999. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group. Ann Intern Med 130:461-70.

Levey AS, Coresh J, Balk E, et al. 2003. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 139:137-47.

Li Y, Zheng Z, Hu S. 2008. Early and long-term outcomes in the elderly: comparison between off-pump and on-pump techniques in 1191 patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 136:657-64.

Lin Y, Zheng Z, Li Y, et al. 2009. Impact of renal dysfunction on long-term survival after isolated coronary artery bypass surgery. Ann Thorac Surg 87:1079-84.

Liu JY, Birkmeyer NJ, Sanders JH, et al. 2000. Risks of morbidity and mortality in dialysis patients undergoing coronary artery bypass surgery. Northern new england cardiovascular disease study group. Circulation 102:2973-7.

Menicanti L, Castelvecchio S, Ranucci M, et al. 2007. Surgical therapy for ischemic heart failure: single-center experience with surgical anterior ventricular restoration. J Thorac Cardiovasc Surg 134:433-41.

Michler RE, Rouleau JL, Al-Khalidi HR, et al. 2013. Insights from the STICH trial: change in left ventricular size after coronary artery bypass grafting with and without surgical ventricular reconstruction. J Thorac Cardiovasc Surg 146:1139-45 e6.

Moran AE, Forouzanfar MH, Roth GA, et al. 2014. The global burden of ischemic heart disease in 1990 and 2010: the Global Burden of Disease 2010 study. Circulation 129:1493-1501.

Nashef SA, Roques F, Michel P, et al. 1999. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 16:9-13.

National Kidney Foundation. 2002. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1-266.

Rouleau JL, Michler RE, Velazquez EJ, et al. 2010. The STICH trial: evidence-based conclusions. Eur J Heart Fail 12:1028-30.

Shafazand M, Schaufelberger M, Lappas G, et al. 2009. Survival trends in men and women with heart failure of ischaemic and non-ischaemic origin: data for the period 1987-2003 from the Swedish Hospital Discharge Registry. Eur Heart J 30:671-8.

Soltero ER, Petersen NJ, Earle NR, et al. 2005. Long-term results of coronary artery bypass grafting in patients with ischemic cardiomyopathy: the impact of renal insufficiency and noncardiac vascular disease. J Card Fail 11:206-12.

Suma H, Horii T, Isomura T, et al. 2006. A new concept of ventricular restoration for nonischemic dilated cardiomyopathy. Eur J Cardiothorac Surg 29 Suppl 1:S207-12.

Wakasa S, Matsui Y, Isomura T, et al. 2014. Risk scores for predicting mortality after surgical ventricular reconstruction for ischemic cardiomyopathy: results of a Japanese multicenter study. J Thorac Cardiovasc Surg 147:1868-1874, 1874.e1-2.

Wong CM, Hawkins NM, Petrie MC, et al. 2014. Heart failure in younger patients: the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC). Eur Heart J 35:2714-21.

Zheng Z, Fan H, Feng W, et al. 2009. Surgery of left ventricular aneurysm: a propensity score-matched study of outcomes following different repair techniques. Interact Cardiovasc Thorac Surg 9:431-6.

Zheng Z, Zhang L, Li X, et al. 2013. SinoSCORE: a logistically derived additive prediction model for post-coronary artery bypass grafting in-hospital mortality in a Chinese population. Front Med 7:477–85.

Published

2018-05-24

How to Cite

Xu, F., Song, Y., Feng, W., Li, X., & Du, J. (2018). Increased Short-Term and Mid-Term Major Complications Were Observed in Elderly Patients with Renal Dysfunction after Surgical Ventricular Restoration. The Heart Surgery Forum, 21(3), E194-E200. https://doi.org/10.1532/hsf.1911

Issue

Section

Article