1 Sajid Khan, 2 Dr .Hussain shah, 3 Dr Baha-ud-din , 4 Dr.Aitizaz Ahsan , 5 Tahir Iqbal
1Senior Registrar, Cardiac Surgery, Peshawar General Hospital.
2 Registrar Cardiovascular and Thoracic Surgery, NWGH & Research Centre Peshawar
3 Associate Professor Cardiothoracic Surgery NWGH & Research Centre Peshawar
4 PGR Cardiac Surgery NWGH & Research Centre Peshawar
5 FCPS Cardiac Surgery, Senior registrar, Dept of Cardiac Surgery, Northwest General Hospital & Research Center, Peshawar
ABSTRACT:
Introduction: Acute renal failure (ARF) is a significant complication following valvular heart surgery, contributing to increased morbidity and mortality. Understanding frequency and identifying dangerous factors related with ARF in these patients is crucial for improving perioperative management and outcomes. Despite advancements in surgical techniques and perioperative care, ARF remains a common and severe issue.
Aim: The primary goal of the research was to explore incidence of ARF in patients undergoing valvular heart surgery and identify preoperative, intraoperative, and postoperative dangerous factors related through their development.
Methods: A retrospective cohort research was led, including 120 patients who underwent valvular heart surgery at a tertiary care hospital between May 2023 and April 2024. Patient data were collected from electronic medical records and included demographic information, comorbidities, type of valvular surgery performed, intraoperative variables, and postoperative outcomes. ARF was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Statistical analyses were performed to determine the incidence of ARF and to identify significant risk factors. Logistic regression models were used to adjust for potential confounders and to identify independent predictors of ARF.
Results: Out of the 120 patients involved in research, 28 (23.3%) developed ARF following valvular heart surgery. The study population had the average age of 65 years, with 60% being male. Preoperative factors such as advanced age, preexisting chronic kidney disease, diabetes mellitus, and left ventricular dysfunction were suggestively related through an enlarged danger of ARF. Intraoperative factors, including longer cardiopulmonary bypass time, use of intra-aortic balloon pump, and higher intraoperative blood transfusion requirements, were also significant predictors of ARF. Postoperative variables, such as low cardiac output syndrome and necessity for prolonged mechanical ventilation, were strongly associated with the development of ARF. The logistic regression model identified advanced age (OR: 2.5, 95% CI: 1.3-4.8), preexisting chronic kidney disease (OR: 3.2, 95% CI: 1.7-6.1), and longer cardiopulmonary bypass time (OR: 2.8, 95% CI: 1.4-5.5) as independent forecasters of ARF.
Conclusion: The incidence of ARF following valvular heart surgery in this study was found to be 23.3%. Advanced age, preexisting chronic kidney disease, and longer cardiopulmonary bypass time were predictable as independent dangerous aspects for development of ARF.
Those results underline importance of meticulous preoperative evaluation, optimization of perioperative care, and close postoperative monitoring for patients at higher risk of ARF. Strategies to minimize cardiopulmonary bypass time and careful management of hemodynamic parameters may help decrease occurrence of ARF in this patient population.
Keywords: Acute renal failure, valvular heart surgery, dangerous factors, cardiopulmonary bypass, chronic kidney disease, perioperative care.