Acute Kidney Injury Classification Underestimates Long-Term Mortality After Cardiac Valve Operations

Hjalmar R. Bouma*, Hubert E. Mungroop, A. Fred de Geus, Daniel D. Huisman, Maarten W. N. Nijsten, Massimo A. Mariani, Thomas W. L. Scheeren, Johannes G. M. Burgerhof, Robert H. Henning, Anne H. Epema

*Bijbehorende auteur voor dit werk

OnderzoeksoutputAcademicpeer review

16 Citaten (Scopus)


Background. Perioperative acute kidney injury (AKI) is an important predictor of long-term all-cause mortality after coronary artery bypass (CABG). However, the effect of AKI on long-term mortality after cardiac valve operations is hitherto undocumented.

Methods. Perioperative renal injury and long-term allcause mortality after valve operations were studied in a prospective cohort of patients undergoing solitary valve operations (n = 2,806) or valve operations combined with CABG (n = 1,260) with up to 18 years of follow-up. Postoperative serum creatinine increase was classified according to AKI staging 0 to 3. Patients undergoing solitary CABG (n = 4,938) with cardiopulmonary bypass served as reference.

Results. In both valve and valve+CABG operations, postoperative renal injury of AKI stage 1 or higher was progressively associated with an increase in long-term mortality (hazard ratio [HR], 2.27, p <0.05 for valve; HR, 1.65, p <0.05 for valve+CABG; HR, 1.56, p <0.05 for CABG). Notably, the mortality risk increased already substantially at serum creatinine increases of 10% to 25%-that is, far below the threshold for AKI stage 1 after valve operations (HR, 1.39, p <0.05), but not after valve operations combined with CABG or CABG only.

Conclusions. An increase in serum creatinine by more than 10% during the first week after valve operation is associated with an increased risk for long-term mortality after cardiac valve operation. Thus, AKI classification clearly underestimates long-term mortality risk in patients undergoing valve operations. (C) 2018 by The Society of Thoracic Surgeons

Originele taal-2English
Pagina's (van-tot)92-98
Aantal pagina's7
TijdschriftAnnals of thoracic surgery
Nummer van het tijdschrift1
Vroegere onlinedatum1-mrt-2018
StatusPublished - jul-2018

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