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eComment. Optimal time interval between cardiac catheterization and cardiac surgery.

I read with great interest the paper by Ozkaynak et al. in which they analysed the time from cardiac catheterization to cardiac surgery as a risk factor for acute kidney injury (AKI) [1]. The optimal timing of cardiac surgery after cardiac catheterization remains controversial. An overwhelming wealth of evidence demonstrated that delaying cardiac surgery for at least 24 hours of exposure to nephrotoxic contrast media should be pursued because AKI remains a frequent complication and is recognized as a significant risk for poor outcome after cardiac surgery [2]. In the current era of stringent budget, there is a strong motivation to decrease in-hospital stay and costs and many institutions have implemented a Policy to reduce the time interval between angiography and cardiac surgery [3-4]. One major limitation of this study is the variability of the type of operations and this could have confounded their outcomes. As numerous authors have reported before, and based on a recent meta-analysis [5], carrying cardiac surgery in close succession to cardiac angiography exposes to an increase risk of AKI, this complication occurs primarily in patients undergoing coronary artery bypass grafting. However, this assumption does not apply in case of aortic valve replacement or proximal aortic surgery. Same day cardiac catheterization and aortic valve replacement is considered by many as a routine practice [3]. Recently, Anderson et al. found that cardiac angiography within 1 to 3 days before proximal aortic surgery is not a risk factor for AKI [4]. The present study offers remarkable insights into the medical management of high risk patients between cardiac catheterization and cardiac surgery. No randomized studies to date have analysed the optimal time interval between exposure to radiocontrast dye during angiography and cardiac surgery. Nonetheless, we emphasize that the only empirical resolution for this debate will necessitate the performance of appropriately powered randomized controlled trials.