acute renal failure after aortic heart valve replacement

[suewerrett]

My 84 year old father underwent aortic heart valve replacement 5 days ago - he suffered a complication and had to go back down with a bad bleed for further surgery - this meant he was under anaesthetic for longer than planned and when they woke him next morning he had been intubated for 24 hours - the heart is now apparently working well, but he is suffering from kidney failure, the op was Weds morning with further surgery to stop the bleeding on the Weds afternoon, when we went to see him on Fri morning they had put him on a kidney dialysis machine - late Sunday they said his bowels had begun to work which was a good sign, and that he was starting to produce very small amounts of urine himself - progress was slow, but this was a good sign.  However, after reading research on the internet, my understanding is that 60-70% of patients who suffer acute renal failure never come out of hospital, and that those that do, often don't survive more than a year.  Can anyone clarify?  I know he is old, but the surgeons keep trying to make light of the dialysis, and say they are hopeful the kidneys will get full function back, although no promises.  After what I have read on the internet I am very worried, and I know my mom is wishing he never had the surgery at all, can anyone enlighten me please - there don't appear to be any other problems other than that they are helping to maintain his blood pressure at the moment as this went a bit low - he is generally quite lucid and concious, although he is hallucinating a litte if that helps.  I would really appreciate any help at all. Thank you.

[suewerrett]

Thank you so much for your comment.  Sometimes I think they don't keep you properly informed at the hospital - don't get me wrong they are incredibly busy people and have been great its just hard to catch them for long on an intensive care ward because they are always rushing about. The difference between when we saw my Dad on August 13thand August 14th was incredible - the dialysis machine was gone and his kidneys had started to function again and quite well, I managed to ask someone to explain properly and they said although they had described him as having acute kidney failure, it was more of a case that they had to rewake the kidneys after the operation.  The surgeon I spoke to also said it shouldn't affect his long term prognosis.  Unfortunately he is very confused and hallucinating a little at the moment and they had to call and ask my mother  and myself to go in to calm him down but they also said what you did about the anaesthetic and the drugs - I also know that his bp did go quite low at one point.  The good news is that physically he is now doing so much better, they have moved him off intensive care, and although he is still high dependency, and has an irregular heart beat at the moment, apparently quite common after surgery, they still seem hopeful that he will recover.  It really is fantastic that they did this surgery at his age, and his valve was badly damaged so he needed it done sooner rather than later, as the Dr had said it could go at any time, and for anyone else reading this don't give up hope, I know we have a long way to go, but you'd be amazed at what difference even a day makes.  

[ed34]

I have no idea why death has to come into the equation here. Firstly they must know the cause. If he had internal bleeding and was rushed back to surgery, did his kidneys suffer from insufficient oxygen for a while? Anaesthetic is more likely to aggravate infection than cause kidney damage, so I hope they've checked for infection as an obvious possible cause. When caused by infection, nearly all kidneys fully recover. However if caused by surgery, then the problem is harder to resolve, but still a high number recover. If it comes to the road where his kidneys are not recovering, then why isn't dialysis a stop gap until a viable donor is found?
The hallucinations are one of two things. Either he had low oxygen due to a drop in blood pressure from the internal bleed, and the brain needs time to recover, or most likely, he is on sedation. The sedation used keeps you between reality and lala land. I would certainly ensure they have checked his white cells in the blood to establish infection possibility, and give powerful antibiotics if needed. Now is the waiting game where nobody has the answers until they happen. Try to keep positive, if his kidneys don't recover, they can keep his blood toxins lower using dialysis and you can discuss transplant. Yes he may be old, but they were willing to change his heart valve at this age, so what is stopping them doing a kidney which is far less aggressive in surgical nature.
Please keep us informed. Oh and from what I've read, it's an average of 7 days for kidneys to start picking up properly again.