Mitral Valve Repair Patients with Rheumatic Valvular Disease

Abstract

with on-pump revascularisation) have focused on the rise in serum creatinine (an insensitive biomarker affected by age, gender, muscle mass, non-specific muscle injury, preoperative renal function and not reflective of tubular injury) or requirement for haemofiltration (a marker of substantial AKI only). We sought to characterise early renal damage after off pump surgery by measurement of a novel biomarker, neutrophil gelatinase associated lipocalin (NGAL), a validated surrogate of AKI. Methods: We measured serum NGAL (normal range 150ng/ml) in unselected consecutive coronary patients, operated off pump, using a standard bedside assay. Measurements were taken after induction of anaesthesia, on arrival in ICU and at 24 h after conclusion of surgery. A further assay was performed prior to infusion of cell-salvaged blood, where necessary. At each time point, simultaneous measurement of serum creatinine was performed. Results:Sevenconsecutivepatientsofmeanage73years (range 60–80 years) underwent complete off pump revascularisation, receiving 3–6 grafts (mean 4.1± 1.0 grafts). Preoperative baseline creatinine was 53–133mcmol/l (mean±SD 82± 27mcmol/l) and estimated glomerular filtration rates were 45–90ml/min. Serum creatinine increased by −7 to 28% during this time. In 4 patients, NGAL remained normal throughout. Two patients had NGAL levels rise marginally but within low AKI risk limMitral Valve Repair Patients with Rheumatic Valvular