Concomitant surgical ablation for atrial fibrillation is associated with increased risk of acute kidney injury but improved late survival
Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved..
BACKGROUND: Acute kidney injury (AKI) after cardiac surgery remains a common complication that has been associated with increased morbidity and mortality. This study implemented Kidney Disease Improving Global Outcomes criteria to evaluate renal outcomes after concomitant surgical ablation for atrial fibrillation.
METHODS: Patients with a history of atrial fibrillation who underwent elective cardiac surgery at our institution from 2008 to 2018 were retrospectively reviewed. Those with preoperative renal dysfunction were excluded. Patients were classified as those who underwent concomitant Cox-Maze IV (CMP-IV) (n = 376) or no surgical ablation (n = 498). Nearest neighbor 1:1 propensity matching was conducted on fourteen covariates. AKI was evaluated by mixed effects logistic regression analysis. Long-term survival was evaluated by proportional hazards regression.
RESULTS: Propensity matching yielded 308 patients in each group (n = 616). All preoperative variables were similar between groups. The concomitant CMP-IV group had a greater incidence of AKI: 32% (n = 99) versus 16% (n = 49), P < .001. After accounting for bypass time and nonablation operations on mixed effects analysis, concomitant CMP-IV was associated with increased risk of AKI (odds ratio, 1.89; confidence interval, 1.12-3.18; P = .017). While AKI was associated with decreased late survival (P < .001), patients who received a concomitant CMP-IV maintained superior 7-year survival to patients who received no ablation (P < .001). No patients required permanent dialysis.
CONCLUSIONS: Concomitant CMP-IV was independently associated with increased risk of AKI in the acute postoperative period. However, the long-term risks of AKI were offset by the significant survival benefit of CMP-IV. Concerns regarding new-onset renal dysfunction should not prohibit recommendation of this procedure in appropriate patients.
| Errataetall: |
CommentIn: J Thorac Cardiovasc Surg. 2022 Dec;164(6):1861-1862. - PMID 33610362 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:164 |
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| Enthalten in: |
The Journal of thoracic and cardiovascular surgery - 164(2022), 6 vom: 15. Dez., Seite 1847-1857.e3 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Bakir, Nadia H [VerfasserIn] |
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| Links: |
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| Themen: |
Acute kidney injury |
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| Anmerkungen: |
Date Completed 04.01.2023 Date Revised 02.03.2023 published: Print-Electronic CommentIn: J Thorac Cardiovasc Surg. 2022 Dec;164(6):1861-1862. - PMID 33610362 Citation Status MEDLINE |
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| doi: |
10.1016/j.jtcvs.2021.01.023 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 100 | 1 | |a Bakir, Nadia H |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Concomitant surgical ablation for atrial fibrillation is associated with increased risk of acute kidney injury but improved late survival |
| 264 | 1 | |c 2022 | |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: J Thorac Cardiovasc Surg. 2022 Dec;164(6):1861-1862. - PMID 33610362 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Acute kidney injury (AKI) after cardiac surgery remains a common complication that has been associated with increased morbidity and mortality. This study implemented Kidney Disease Improving Global Outcomes criteria to evaluate renal outcomes after concomitant surgical ablation for atrial fibrillation | ||
| 520 | |a METHODS: Patients with a history of atrial fibrillation who underwent elective cardiac surgery at our institution from 2008 to 2018 were retrospectively reviewed. Those with preoperative renal dysfunction were excluded. Patients were classified as those who underwent concomitant Cox-Maze IV (CMP-IV) (n = 376) or no surgical ablation (n = 498). Nearest neighbor 1:1 propensity matching was conducted on fourteen covariates. AKI was evaluated by mixed effects logistic regression analysis. Long-term survival was evaluated by proportional hazards regression | ||
| 520 | |a RESULTS: Propensity matching yielded 308 patients in each group (n = 616). All preoperative variables were similar between groups. The concomitant CMP-IV group had a greater incidence of AKI: 32% (n = 99) versus 16% (n = 49), P < .001. After accounting for bypass time and nonablation operations on mixed effects analysis, concomitant CMP-IV was associated with increased risk of AKI (odds ratio, 1.89; confidence interval, 1.12-3.18; P = .017). While AKI was associated with decreased late survival (P < .001), patients who received a concomitant CMP-IV maintained superior 7-year survival to patients who received no ablation (P < .001). No patients required permanent dialysis | ||
| 520 | |a CONCLUSIONS: Concomitant CMP-IV was independently associated with increased risk of AKI in the acute postoperative period. However, the long-term risks of AKI were offset by the significant survival benefit of CMP-IV. Concerns regarding new-onset renal dysfunction should not prohibit recommendation of this procedure in appropriate patients | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Cox-Maze IV procedure | |
| 650 | 4 | |a acute kidney injury | |
| 650 | 4 | |a dialysis | |
| 650 | 4 | |a propensity score match | |
| 650 | 4 | |a renal failure | |
| 650 | 4 | |a surgical ablation | |
| 700 | 1 | |a Khiabani, Ali J |e verfasserin |4 aut | |
| 700 | 1 | |a MacGregor, Robert M |e verfasserin |4 aut | |
| 700 | 1 | |a Kelly, Meghan O |e verfasserin |4 aut | |
| 700 | 1 | |a Sinn, Laurie A |e verfasserin |4 aut | |
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