“We have developed a protocol to allow patients to safely have coronary angiography on the same day as their elective surgery,” says David Holmes Jr., M.D., a cardiologist at Mayo Clinic and one of the authors of the new study.
One of the primary concerns of performing coronary angiography the same day as surgery is the risk of acute kidney failure, an independent predictor of death after cardiac surgery; mortality rates have been reported as high as 44.4 percent to 63.7 percent, the researchers report. The dye used in angiography is associated with radiocontrast-induced nephropathy, which can cause kidney failure.
When worsening kidney function occurs, serum creatinine levels begin to increase after 24 to 72 hours, peak within three to five days and return to normal within another three to five days, thus the reason for the delay between the angiography and surgery, Holmes explains.
Mayo researchers evaluated the medical records of 226 consecutive patients who had undergone cardiac catheterisation on the day of elective valve repair or replacement. The average age of the patient was 65 years old and 33 percent were female. Of the 226, angiography showed that 28.3 percent had severe enough coronary artery disease to also require bypass surgery, in addition to valve surgery. One patient died within 30 days following surgery, and four of the patients had transient renal failure.
To make it possible to do angiography and surgery on the same day and largely diminish the possibility of renal failure, the physicians used other contrast agents. They minimized the total amount of contrast and carefully screened patients at risk for kidney disease. Different agents are used based on the patient’s kidney function, Holmes says. “In addition, deciding which patients may benefit from this streamlined approach is dependent on careful patient assessment and collaboration between the cardiologist and cardiovascular surgeon,” he says.
MEDICA.de; Source: Mayo Clinic