Early surgery after angiography in patients scheduled for valve replacement

Abstract

Background

There are limited data regarding the risks of cardiac surgery early after coronary angiography in patients scheduled for isolated aortic and/or mitral valve replacement. Our aim was to evaluate the risk of early surgery after coronary angiography in these patients.

Methods

We retrospectively analyzed data of 1044 patients who underwent isolated aortic and/or mitral valve replacement from 2006 to 2014. Baseline, operative, and postoperative variables were collected. The patients were divided into 3 groups based on the interval between coronary angiography and surgery: ≤3 days (n = 216), 4–7 days (n = 109), and ≥8 days (n = 719). We evaluated hospital mortality and postoperative acute kidney injury. Subgroup analysis was performed according to preoperative creatinine clearance.

Results

Postoperative creatinine clearance was lower in patients who underwent surgery ≤3 days after coronary angiography (63.57 ± 38.52 mL min⁻¹) compared to ≥8 days after coronary angiography (74.56 ± 54.25 mL min⁻¹, p = 0.015). Patients who underwent surgery ≤3 days after coronary angiography had higher hospital mortality when preoperative creatinine clearance was ≤60 mL min⁻¹ (12% vs. 4% for creatinine clearance ≤and >60 mL min⁻¹, respectively; p = 0.039). Predictors of hospital mortality were New York Heart Association class and postoperative creatinine clearance.

Conclusion

Hospital mortality was higher in patients with decreased preoperative renal function who underwent surgery within the first 3 days after coronary angiography. Delaying surgery in this subgroup of patients could be a good strategy.