Key result
Preoperative eGFR <60 predicts a ~92% higher risk of late MACE after mitral valve surgery.
Why the study?
The role of renal dysfunction in outcomes after mitral valve surgery has been limitedly documented.
Does preoperative eGFR <60 ml/min/1.73 m2 predict late cardiovascular morbidity in patients undergoing mitral valve surgery?
Cohort (n=210)
No
Does preoperative eGFR <60 ml/min/1.73 m2 predict late cardiovascular morbidity in patients undergoing mitral valve surgery?
Hazard Ratio: 1.92 (95% CI 1.02–3.68)
p-value: p=0.044
Preoperative eGFR <60 ml/min/1.73 m2 is an independent predictor of late major adverse cardiovascular events after mitral valve surgery, despite acceptable survival rates.
May support preoperative eGFR for risk stratification after mitral valve surgery; hypothesis-generating for targeted renal interventions.
PURPOSE: Renal dysfunction affects outcomes of cardiac surgery, although its role in mitral valve operation has been limitedly documented. METHODS: Two hundred and ten patients who underwent mitral valve operation between 2004 and 2011 were divided into 3 groups according to preoperative estimated glomerular filtration ratio (eGFR): group A (eGFR ≥60 ml/min/1.73 m(2), n = 102), group B (eGFR, 59-30 ml/min/1.73 m(2), n = 92) and group C (eGFR <30 ml/min/1.73 m(2), n = 16). RESULTS: Freedom from all-cause and cardiovascular death at 5 years was 77.2% and 93.0%, respectively. No significant differences existed between the 3 groups. In contrast, there was a significant difference in freedom from major adverse cardiovascular events (MACE) between groups (70.4%, 57.1%, and 42.8% in group A, B, and C, respectively; p = 0.008). By univariate and multivariate analysis, eGFR <60 ml/min/1.73 m(2) (HR: 1.92, 95% CI: 1.02-3.68, p = 0.044) and left ventricular ejection fraction <40% (HR: 2.69, 95% CI: 1.17-6.23, p = 0.02) were independent risk factors of MACE, although serum creatinine failed to represent an independent risk factor. CONCLUSION: Patients who underwent mitral valve surgery had acceptable perioperative and long-term survival, irrespective of preoperative renal function. However, eGFR <60 ml/min/1.73 m(2) was an independent predictor of late MACE.
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Nakazato et al. (2013) conducted a cohort in Mitral regurgitation requiring mitral valve surgery (n=210). Preoperative estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 vs. eGFR ≥60 ml/min/1.73 m2 was evaluated on Major adverse cardiovascular events (MACE) (HR 1.92, 95% CI 1.02-3.68, p=0.044). Preoperative estimated glomerular filtration rate <60 ml/min/1.73 m2 independently predicted late major adverse cardiovascular events after mitral valve surgery (HR 1.92).
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