Document Detail


Acute renal failure after cardiac surgery for carcinoid heart disease: incidence, risk factors, and prognosis.
MedLine Citation:
PMID:  15861347     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cardiac surgery for carcinoid heart disease may be associated with acute renal failure (ARF) and multiorgan dysfunction postoperatively. This study was performed to determine the incidence, risk factors, and prognosis of ARF after cardiac surgery for carcinoid heart disease. METHODS: This is a case-control study of 86 consecutive patients who underwent cardiac surgery for carcinoid heart disease. ARF is defined as hemodialysis requirement or serum creatinine level 50% greater than baseline, resulting in an estimated creatinine clearance less than 40 mL/min (0.67 mL/s). Preoperative, operative, and postoperative characteristics were examined and compared between groups to determine risk factors and prognosis of ARF. RESULTS: ARF occurred in 22% of cases (19 of 86 patients). Preoperative characteristics and type of procedure did not differ between groups. Operative variables associated with ARF by means of univariate analysis included longer surgical and bypass times, intra-aortic balloon pump use, and perioperative epinephrine requirement. Postoperatively, ARF was associated with epinephrine use, prolonged mechanical ventilation, prolonged intensive care unit admission, and higher Acute Physiology and Chronic Health Evaluation II scores. Perioperative mortality in the ARF group was 47% versus 4.5% in the control group (odds ratio, 36.1; 95% confidence interval, 8.0 to 261.8). CONCLUSION: ARF developed in a relatively high proportion of this cohort, but traditional preoperative risks failed to predict post-cardiac surgery ARF. Variables closely related to perioperative hemodynamic compromise were associated with ARF. ARF portends a particularly poor prognosis in this cohort that is explained largely by multiorgan failure syndrome.
Authors:
Kevin R Regner; Heidi M Connolly; Hartzell V Schaff; Robert C Albright
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  45     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2005 May 
Date Detail:
Created Date:  2005-04-29     Completed Date:  2005-10-13     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  826-32     Citation Subset:  IM    
Affiliation:
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA. regner.kevin@mayo.edu
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MeSH Terms
Descriptor/Qualifier:
APACHE
Aged
Carcinoid Heart Disease / surgery*
Cardiac Surgical Procedures / statistics & numerical data
Cardiopulmonary Bypass / adverse effects,  statistics & numerical data
Cohort Studies
Comorbidity
Female
Heart Valve Prosthesis Implantation / statistics & numerical data
Hospital Mortality
Humans
Incidence
Kidney Failure, Acute / epidemiology*,  etiology,  therapy
Male
Middle Aged
Minnesota / epidemiology
Multiple Organ Failure / etiology,  mortality
Postoperative Complications / epidemiology*,  etiology
Prognosis
Renal Dialysis / methods
Retrospective Studies
Risk Factors
Sepsis / complications,  mortality
Treatment Outcome
Tricuspid Valve Insufficiency / complications,  surgery

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