The relationship between renal function and outcome from heart valve surgery

Patrick H Gibson, Bernard L Croal, Brian H Cuthbertson, Mildred Chiwara, Anne E Scott, Keith G Buchan, Hussein El-Shafei, George Gibson, Robert R Jeffrey, Graham S Hillis

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

BACKGROUND: The prognostic importance of renal function in patients undergoing surgery for valvular heart disease is poorly defined. The current study addresses this issue.

METHODS: Baseline demographic and clinical variables, including the European system for cardiac operative risk evaluation (EuroSCORE), were recorded prospectively from 514 consecutive patients undergoing heart valve surgery between April 2000 and March 2004. Patients with active infective endocarditis and/or requiring emergency surgery were excluded. The glomerular filtration rate was estimated (eGFR) using the Modification of Diet in Renal Disease equation. The primary outcome was all-cause mortality.

RESULTS: During a median follow-up of 2 years, 87 patients died. In univariable analysis, both eGFR (hazard ratio [HR] 0.69 per 10 mL/min per 1.73 m2, P<.001) and creatinine (HR 1.04 per 10 micromol/L, P<.001) predicted mortality. Estimated GFR was a stronger predictor and was used in subsequent multivariable models. It remained a powerful independent predictor of death in a multivariable model including all study variables (HR 0.70 per 10 mL/min per 1.73 m2 increase, P<.001) and in a model including EuroSCORE (HR 0.64 per 10 mL/min per 1.73 m2 increase, P<.001). After correction for preoperative EuroSCORE, an eGFR of <60 mL/min per 1.73 m2 was associated with an excess hazard of death of 2.31 (P=.001).

CONCLUSION: Renal function, particularly the eGFR, is a powerful predictor of outcome in patients undergoing heart valve surgery. This prognostic utility is independent of other recognized risk factors and the EuroSCORE.

Original languageEnglish
Pages (from-to)893-9
Number of pages7
JournalAmerican Heart Journal
Volume156
Issue number5
DOIs
Publication statusPublished - Nov 2008
Externally publishedYes

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