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Thorac Cardiovasc Surg 2021; 69(05): 396-404
DOI: 10.1055/s-0040-1710318
Original Cardiovascular

Predictors of Acute Kidney Injury Following Surgical Valve Replacement

Khalid S. Ibrahim 
1   Division of Cardiac Surgery, Department of General Surgery and Urology, College of Medicine, Jordan University of Science and Technology, Irbid, Jordan
2   Princess Muna Center for Heart Diseases and Surgery, King Abdullah University Hospital, Irbid, Jordan
,
Khalid A. Kheirallah
3   Department of Public Health and Community Health, College of Medicine, Jordan University of Science and Technology, Irbid, Jordan
,
Fadia A. Mayyas
4   Department of Clinical Pharmacy, College of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
,
Nizar A. Alwaqfi
1   Division of Cardiac Surgery, Department of General Surgery and Urology, College of Medicine, Jordan University of Science and Technology, Irbid, Jordan
2   Princess Muna Center for Heart Diseases and Surgery, King Abdullah University Hospital, Irbid, Jordan
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Abstract

Background Acute kidney injury is a serious complication after surgical valve replacement and holds increased mortality rates.

Objectives To study predictors of acute kidney injury after surgical valve replacement.

Materials and Methods Patients who underwent valve surgery procedures at our center were included. Procedures included aortic valve replacement (AVR), mitral valve replacement (MVR), AVR with coronary artery bypass grafting (CABG), MVR with CABG, or AVR and MVR with/without CABG.

Results A total of 346 patients were included. The mean age was 51.56 (16.1). Males (n = 178) comprised 51%.

At the univariate level analysis, predictors of acute kidney injury were found including age, ejection fraction, hypertension, history of CAD, emergency surgery, recent myocardial infarction, diabetes, atrial fibrillation, history of heart failure, mitral regurgitation (MR), pump time >120 minutes, aortic cross clamp >90 minutes, perioperative blood transfusion, re-exploration for bleeding, use of mechanical and biologic valve in aortic position, use of biologic valve in mitral position, prolonged inotropic support, postoperative stroke, and use of angiotensin converting enzyme inhibitors (ACEi) < a month, (all p < 0.05).

By Logistic regression analysis, Age (p < 0.0001, odds ratio[AOR] = 1.076), hypertension (p = 0.039, AOR = 1.829), heart failure (p = 0.019, AOR = 2.448), MR (p = 0.0001, AOR = 3.110), use of ACEi <month (p = 0.043, AOR= 2.181), pump time >120 minutes (p = 0.022, AOR = 1.797), perioperative blood transfusion (p = 0.008, AOR = 2.532), and prolonged inotropic support (p = 0.012, AOR = 2.591) were significant and independent predictors of AKI.

Conclusion Independent predictors of acute kidney injury following valve surgeries include age, hypertension, heart failure, MR, use of ACEi <month, perioperative blood transfusion, and prolonged pump time or inotropic support.

Keywords

acute kidney injury - valve surgery - coronary artery bypass surgery


Publication History

Received: 19 August 2019

Accepted: 06 March 2020

Article published online:
25 July 2020

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