Atherosclerosis of the ascending aorta is a predictor of renal dysfunctionafter cardiac operations

Objectives: Renal dysfunction occurring after cardiac operations has been a ttributed to various factors, but the importance of an atherosclerotic thor acic aorta has not been previously evaluated. The purpose of this study was to identify predictors of postoperative renal dysfunction (50% or more inc rease from preoperative values) and to evaluate the importance of atheroscl erosis of the ascending aorta as a predictor of this complication, Methods: Nine hundred seventy-eight consecutive patients, 50 years of age and older with normal preoperative renal function (serum creatinine level of 1.5 mg/ dL or less), who were scheduled to undergo cardiac surgery were prospective ly evaluated. Atherosclerosis of the ascending aorta was assessed during th e operation (with epiaortic ultrasound), and patients were divided into 3 g roups according to its severity (normal-to-mild, moderate, and severe). Res ults: Univariate predictors of renal dysfunction at postoperative day 1 wer e atherosclerosis of the ascending aorta (P <.045) and postoperative low ca rdiac output (P =.05); at postoperative day 6 they were atherosclerosis of the ascending aorta (P <.0001), postoperative low cardiac output (P <.0001) , advanced age (P =.001), decreased preoperative left ventricular function (P =.01), and female gender (P =.03), Multivariate analysis showed that ath erosclerosis of the ascending aorta (odds ratio, 3.06; P =.04) was the only independent predictor of postoperative renal dysfunction at day 1 and that postoperative low cardiac output (odds ratio, 4.83; P <.0001), atheroscler osis of the ascending aorta (odds ratio, 2.13; P =.0006), and preoperative left ventricular dysfunction (odds ratio, 1.48; P =.028) were independent p redictors of postoperative renal dysfunction at day 6, Conclusions: An athe rosclerotic ascending aorta is an important predictor of postoperative rena l dysfunction, possibly because atheroembolism to the kidneys occurs in the perioperative period tie, during surgical manipulation of an atherosclerot ic aorta) or because the diseased aorta may be a marker of widespread ather osclerotic disease that may predispose to perioperative renal dysfunction.