Safety of same-day coronary angiography in patients undergoing elective valvular heart surgery.

OBJECTIVE To maximize patient convenience, we developed a protocol for coronary angiography the same day as elective valvular surgery. PATIENTS AND METHODS We analyzed the medical records from a single surgical service of 226 consecutive patients who had undergone cardiac catheterization on the day of elective valvular repair or replacement between August 1, 2000, and August 30, 2004. The rates of renal failure (creatinine >2.0 mg/dL and 2 times the preoperative level), hemodialysis, continuous renal replacement therapy, and mortality were evaluated. RESULTS Patients undergoing same-day angiography had a mean age of 65.6 plus-or-minus 12.1 years, and 33% were female. Of the study patients, 11.1% were diabetic, with a mean ejection fraction of 61% plus-or-minus 10%, and 28.3% had coronary artery disease severe enough to require bypass grafting. One patient died within 30 days of surgery; the overall mortality was 0.4%. Postoperatively, serum creatinine levels increased an average of 0.1 mg/dL (P<.001) in patients undergoing same-day coronary angiography. Four patients had transient renal failure (1.8%), 2 of whom required temporary hemodialysis. CONCLUSION In properly selected patients, same-day coronary angiography is safe and has little impact on renal function. This protocol offers a simple way to reduce the number of hospital visits required by patients undergoing elective valvular surgery.

[1]  J. Carver,et al.  Contrast-induced nephropathy and cardiac catheterization: evidence in support of using the iso-osmolar contrast agent iodixanol in patients with renal dysfunction. , 2005, The Journal of invasive cardiology.

[2]  S. Weisbord,et al.  Radiocontrast-Induced Acute Renal Failure , 2005, Journal of intensive care medicine.

[3]  R. Bersin,et al.  Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. , 2004, JAMA.

[4]  M. Fox,et al.  Valvular heart operation is an independent risk factor for acute renal failure. , 2003, The Annals of thoracic surgery.

[5]  David Roth,et al.  Radiocontrast-induced nephropathy. , 2003, American journal of therapeutics.

[6]  Sven-Göran Fransson,et al.  Nephrotoxic effects in high-risk patients undergoing angiography. , 2003, The New England journal of medicine.

[7]  S. Tobe,et al.  Renal dysfunction after cardiac surgery. , 2001, The Canadian journal of cardiology.

[8]  W Zidek,et al.  Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. , 2000, The New England journal of medicine.

[9]  K E Hammermeister,et al.  Independent association between acute renal failure and mortality following cardiac surgery. , 1998, The American journal of medicine.

[10]  D. Mangano,et al.  Renal Dysfunction after Myocardial Revascularization: Risk Factors, Adverse Outcomes, and Hospital Resource Utilization , 1998, Annals of Internal Medicine.

[11]  V. Salandin,et al.  Acute renal failure in the patient undergoing cardiac operation. Prevalence, mortality rate, and main risk factors. , 1994, The Journal of thoracic and cardiovascular surgery.

[12]  S. Hallhagen,et al.  Acute Renal Failure after Coronary Surgery - A Study of Incidence and Risk Factors in 2009 Consecutive Patients , 1993, The Thoracic and cardiovascular surgeon.