Outcome of elective total aortic arch replacement in patients with non-dialysis-dependent renal insufficiency stratified by estimated glomerular filtration rate

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• 作者：Kenji Okada ; Atsushi Omura ; Hiroya Kano ; Hidekazu Nakai ; Shunsuke Miyahara ; Hitoshi Minami ; Yutaka Okita
• 关键词：CABG ; coronary artery bypass grafting ; CHDF ; continuous hemodiafiltration ; eGFR ; estimated glomerular filtration rate ; GFR ; glomerular filtration rate ; HD ; hemodialysis ; MACCE ; major adverse cerebrocardiovascular events ; OR ; odds ratio ; RRT ; renal replacement therapy ; TAR ; total aortic arch replacement
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：March, 2014
• 年：2014
• 卷：147
• 期：3
• 页码：966-972.e2
• 全文大小：192 K

文摘

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Objective

Little is known about the impact of preoperative renal function stratified by estimated glomerular filtration rate (eGFR) on outcomes of total aortic arch replacement (TAR). The current study addressed this issue and identified a cutoff value of eGFR for the requirement of postoperative renal replacement therapy.

Methods

From January 2000 to May 2011, 229 consecutive patients who did not require preoperative hemodialysis were retrospectively studied after elective TAR. Patients were grouped into the following categories: those with normal renal function (eGFR >90 mL/min/1.73 m²; n聽=聽11) and those with mild (eGFR, 60-90 mL/min/1.73 m²; n聽=聽86), moderate (eGFR, 30-59 mL/min/1.73 m²; n聽=聽111), or severe (eGFR <30 mL/min/1.73 m²; n聽=聽21) renal dysfunction. Linear trend tests demonstrated that the lower categories of eGFR were associated with a higher age, hypertension, coronary artery disease, peripheral arterial disease, and a higher EuroSCORE II.

Results

The overall hospital mortality was 2.2%. A lower categories of eGFR were an independent risk factor for hospital mortality (odds ratio, 0.91; P聽=聽.002) and postoperative renal replacement therapy (odds ratio, 0.94; P聽<聽.002). A cutoff value for the requirement of postoperative renal replacement therapy was 26.0 mL/min/1.73 m². Patients in the lower categories of eGFR had significantly higher hospital mortality (P聽=聽.03) and more morbidities, such as renal replacement therapy (P聽<聽.01), postoperative permanent neurologic deficits (P聽=聽.013), and prolonged mechanical ventilatory support (P聽<聽.01). Midterm survival and freedom from major adverse cerebrocardiovascular events were worse across the levels of the lower categories of eGFR.

Conclusions

Preoperative eGFR is a strong predictor of short- and midterm outcomes in contemporary TAR.