Incidence of acute renal failure after emergent surgical myocardial revascularization in acute myocardial infarction

Objective: Chronic renal failure is a frequent disease in patients suffering from cardiovascular disease. After cardiac surgery, the postoperative acute renail failure is a severe complication. In this study the incidence of acute renal failure (ARF) after emergent surgical revascularization requiring continuous veno-veneous hemodialysis (CVVHD) was analyzed.

Patients: In this retrospective study, 277 patients, operated between 1/2000 and 5/2008, were investigated.

Results: Chronic renal failure was pre-operatively present in 35% (98/277) of the patients without the need of dialysis. After surgery, 17 of 98 patients need CVVHD. Additionally 21 patients with a pre-operative normal creatinine level required postoperative CVVHD.

The use of epinephrine during extra-corporeal circulation (ECC) (p<0.01), a prolonged operation time (p<0.005), a prolonged bypass time (p<0.0002), and a postoperatively elevated CK level (p<0.00001) were associated with postoperative ARF.

A total of 14% of these patients (38/277) had a postoperative ARF with consecutive CVVHD. 6.5% of them survived (18/277) (Odds Ratio 2.3, CI 95%, p=0.02). The occurence of ARF with the need of CVVDH was associated with an increased mortality (p<0.01).

Conclusion: The data demonstrates that ARF after emergent myocardial revascularization is a severe, life threatening complication. Therefore careful hemodynamic and volume management during ECC, short ECC times, and the postoperative securing of the tubular function of the kidneys seems to be important to prevent ARF, especially in these high-risk patients.