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Acute renal failure and open heart surgery
Abstract:
A retrospective study of 428 open heart operations showed the incidence of mild and severe renal failure to be 26% and 4.7% respectively. The mortality rate was 38% in the mild cases and 70% in the severe cases. Only half of the patients whose death was associated with renal failure showed macroscopic or microscopic renal lesions at necropsy. The patients who developed renal impairment had significantly higher mean preoperative blood urea (40 mg/100 ml) than the non-renal-failure cases (33 mg/100 ml). Periods of perfusion over 60 minutes, mean perfusion pressures below 80 mm Hg, and multiple valve replacement operations also increased the incidence of renal failure. There was no statistical correlation between the age of individual patients, the degree of cooling, and postoperative blood urea values. There was no evidence to suggest that frusemide or mannitol separately or together influenced the development of renal failure. Peritoneal dialysis was preferred for initial treatment of patients with severe renal failure, and haemodialysis was required only in special cases.
Insights
This study found that 26% of open heart surgery patients experienced mild renal failure and 4.7% severe renal failure, with higher mortality in severe cases. Key risk factors included longer perfusion times and multiple valve replacements.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Critical Care Medicine
Background:
- Renal failure is a significant complication following open heart operations.
- Understanding risk factors and outcomes is crucial for patient management.
Purpose of the Study:
- To investigate the incidence, mortality, and risk factors associated with renal failure after open heart surgery.
- To evaluate the effectiveness of different dialysis methods for renal failure post-cardiac surgery.
Main Methods:
- Retrospective analysis of 428 open heart operations.
- Comparison of preoperative and postoperative renal function markers.
- Identification of surgical and patient-related risk factors.
Main Results:
- Incidence of mild and severe renal failure was 26% and 4.7%, respectively.
- Mortality rates were 38% (mild) and 70% (severe) renal failure.
- Increased risk associated with perfusion >60 min, perfusion pressure <80 mm Hg, and multiple valve replacements. Preoperative blood urea was significantly higher in patients with renal impairment.
- No correlation found with age, cooling degree, or postoperative blood urea. Diuretics (frusemide, mannitol) showed no influence.
Conclusions:
- Renal failure is common and carries high mortality after open heart surgery.
- Specific surgical parameters significantly increase renal failure risk.
- Peritoneal dialysis is the preferred initial treatment for severe renal failure post-cardiac surgery.