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| Cardiac Catheterization Within 24 Hours of Valve Surgery is Significantly Associated with Acute Renal Failure |
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Sara A. Hennessy, Damien J. LaPar, George J. Stukenborg, John A. Kern, Benjamin B. Peeler, Gorav Ailawadi, Irving L. Kron; Department of Surgery, University of Virginia, Charlottesville, VA Objective: Acute renal failure (ARF) after valve surgery carries a significant morbidity and mortality. Preoperative cardiac catheterization is a standard of care; however, it is unclear whether timing of radiocontrast administration for catheterization significantly effects renal function after valve surgery. We hypothesized that preoperative cardiac catheterization within 24 hours of valve surgery would be associated with the development of acute renal failure. Methods: A large retrospective review of all patients undergoing heart valve surgery between 2003 and 2008 was performed at our institution. ARF was defined according to the Society of Thoracic Surgery Database criteria and patients with preoperative renal dysfunction were excluded. Patients with postoperative ARF were matched to those without postoperative ARF according to their age, sex, date of surgery, NYHA class, elective versus urgent/emergent status, concomitant CABG and type of valve surgery. A logistic regression model was constructed to examine the effects of risk factors on the development of acute renal failure. Results: Out of 1,287 heart valve surgery patients, 61 patients with ARF were matched to 136 patients without ARF. The two groups were equivalent based on matching criteria, including emergent/urgent status. Cardiac catheterization within 24 hours of surgery was significantly greater in patients with ARF than in those without ARF (31.2% versus 8.8%, p=0.013). The risk of ARF was more than 5 times higher (OR 5.2) for patients with cardiac catheterization within 24 hours of surgery as compared to patients with cardiac catheterization more than 72 hours before surgery. As demonstrated in Figure 1 the incidence of ARF decreases as time from cardiac catheterization to surgery increases. Interestingly, the number of vasopressors given within the first 6 hours after surgery was significantly associated with postoperative ARF (p=0.0135). The risk of ARF increases 2 fold for every additional vasopressor given (OR 2.08). Conclusion: Though it is often performed for patient convenience, cardiac catheterization within 24 hours of valve surgery is significantly associated with the development of acute renal failure. Current practices may need to be adjusted to ensure that more than 24 hours have passed from the time of cardiac catheterization to time of valve surgery. 
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