Acute kidney injury during aortic arch surgery under deep hypothermic circulatory arrest

Mori, Yosuke; Sato, Nobukazu; Kobayashi, Yoshiro; Ochiai, Ryoichi

doi:10.1007/s00540-011-1210-8

Cited by 36 publications

(31 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The logistic regression model identified DHCA time >30 minutes as an independent risk factor for AKI, which was consistent with a previous study. 24 Meanwhile, in a previous study reported by Englberger et al, 3 the use of DHCA was not an independent risk factor. This study did not exclude the influence of patient demographics from the multivariate analysis, and provided increased age, elevated BMI and a history of hypertension as independent risk factors.…”

Section: Discussionmentioning

confidence: 81%

“…Demographic variables previously reported as risk factors for AKI were included such as age, 3 , 6 , 7 gender 7 and BMI. 3 A past medical history of hypertension, 2 , 3 , 24 diabetes mellitus, 7 , 9 , 10 smoking history, 9 and cerebrovascular accident 11 have also been reported as predictors for AKI and were included here. However, these factors could function as confounders of attempts to find independent risk factors for AKI, and their clinical significance is limited as these are not modifiable.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Potentially Modifiable Risk Factors For Acute Kidney Injury After Surgery on The Thoracic Aorta

et al. 2015

View full text Add to dashboard Cite

Perioperative risk factors were identified for acute kidney injury (AKI) defined by the RIFLE criteria (RIFLE = risk, injury, failure, loss, end stage) after surgery on the thoracic aorta with cardiopulmonary bypass (CPB) in this case-control study.A retrospective review was completed for 702 patients who underwent surgery on the thoracic aorta with CPB. A total of 183 patients with AKI were matched 1:1 with patients without AKI by a propensity score. Matched variables included age, gender, body-mass index, preoperative creatinine levels, estimated glomerular filtration rate, a history of hypertension, diabetes mellitus, cerebrovascular accident, smoking history, or chronic obstructive pulmonary disease to exclude the influence of patient demographics, preoperative medical status, and baseline renal function. Multivariate logistic regression analysis was used to evaluate for independent risk factors in the matched sample of 366 patients.The incidence of AKI was 28.6% and 5.9% of patients from the entire sample required renal replacement therapy. AKI was associated with a prolonged postoperative hospital stay and a higher one-month and one-year mortality both in the entire and matched sample set. Independent risk factors for AKI were a left ventricular ejection fraction <55%, preoperative hemoglobin level <10 g/dL, albumin <4.0 g/dL, diagnosis of dissection, operation time >7 hours, deep hypothermic circulatory arrest (DHCA) time >30 min, pRBC transfusion >1000 mL, and FFP transfusion >500 mL. Although the incidence of poor glucose control (blood glucose >180 mg/dL) was higher in patients with AKI in matched sample, it was not an independent risk factor.AKI was still associated with a poor clinical outcome in the matched sample. Potentially modifiable risk factors included preoperative anemia and hypoalbuminemia. Efforts to minimize operation time and DHCA time along with transfusion amount may protect patients undergoing aortic surgery against AKI.

show abstract

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Potentially Modifiable Risk Factors For Acute Kidney Injury After Surgery on The Thoracic Aorta

et al. 2015

View full text Add to dashboard Cite

show abstract

“…ARF = acute renal failure; HCA = hypothermic circulatory arrest. more protective towards the visceral organs and kidneys, new clinical trends advocate moderate hypothermia without compromise in renal function [11][12][13].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Implications of Acute Renal Failure after Surgery for Type A Acute Aortic Dissection

Sansone

Morgante

Ceresa

et al. 2015

Aorta

View full text Add to dashboard Cite

Background: "Type A" acute aortic dissection (AAAD) is the most challenging among the emergency operations in cardiac surgery. The aim of this study was the evaluation of the role of acute renal failure (ARF) in postoperative survival of patients operated for AAAD. Methods: From February 2010 to April 2012, 37 consecutive patients were operated at our department for AAAD. We studied our population by subdividing the patients within groups according to the presence of ARF requiring continuous veno-venous hemofiltration (CVVH) and according to hypothermic circulatory arrest (HCA) times and degrees. Results: The overall 30-day mortality was 27% (50% group A with ARF, 13% group B no ARF). Acute renal failure requiring CVVH was 37.8%. Multivariate analysis revealed a significant association with 30-day mortality (odds ratio 6.6 and p = 0.020). Preoperative oliguria [urine output less than 30 ml/h (odds ratio 4.7 p = 0.039)], CPB greater than 180 minutes (odds ratio 6.5 p = 0.023) and postoperative bleeding requiring a surgical reopening (odds ratio 12.2 and p = 0.021) were the variables significantly associated with acute kidney injury. Conclusions: The data obtained from our analysis bring out the high incidence of renal injuries after surgery for AAAD, and indicate a negative impact on renal injuries of a preoperative oliguria, longer Cardiopulmonary bypass (CBP)/HCA times, and postoperative bleeding requiring a surgical revision. Our data also suggest a better 30-day survival and better renal outcomes in case of shorter HCA and lesser degree of hypothermia.The option of lesser and shorter hypothermia may be very useful, especially for the elderly patients and octogenarians.

show abstract

“…In multivariable models, estimates were adjusted for the following risk factors for AKI following cardiac or thoracic aortic surgery: age, sex, body mass index, baseline estimated glomerular filtration rate, hypertension, diabetes mellitus, CHF, CPB duration, use of DHCA, ejection fraction, preoperative hemoglobin, and aprotinin exposure (1-3, 7, 18). Concomitant CABG was further included in the model as a surrogate for coronary artery disease and because patients undergoing CABG surgery have been shown to be at higher risk of AKI with short interval catheterization (6-9, 11).…”

Section: Methodsmentioning

confidence: 99%

Cardiac catheterization within 1 to 3 days of proximal aortic surgery is not associated with increased postoperative acute kidney injury

Andersen

Williams

Fosbøl

et al. 2012

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

Objective Cardiac catheterization shortly before coronary artery bypass grafting or valve surgery has been associated with increased postoperative acute kidney injury. The relationship between catheterization timing and acute kidney injury following proximal aortic surgery remains unknown. Methods Between August 2005 and February 2011, 285 consecutive patients underwent cardiac catheterization prior to elective proximal aortic surgery with cardiopulmonary bypass at a single institution. The association between timing of catheterization and postoperative acute kidney injury (defined as postoperative increase in serum creatinine ≥ 50% of baseline) was assessed using logistic regression analysis. Results Of 285 patients, 152 (53%) underwent catheterization on preoperative days 1-3 and 133 (47%) underwent catheterization on preoperative day 4 or before. Acute kidney injury occurred in 88 (31%) patients, three (1.1%) requiring dialysis. Acute kidney injury occurred in 37 (24%) patients catheterized on preoperative days 1-3, and 51 (38%) patients catheterized on preoperative day 4 or before. Catheterization on preoperative day 1-3 was not associated with an increased risk of acute kidney injury relative to catheterization on preoperative day 4 or before (unadjusted odds ratio 0.52, 95% confidence interval 0.31–0.86, P = 0.01; adjusted odds ratio 0.35, 95% confidence interval 0.17–0.73, P = 0.005). Conclusions Cardiac catheterization within one to three days of elective proximal aortic surgery appears safe and should be considered acceptable practice for patients at low-risk of acute kidney injury.

show abstract

Acute kidney injury during aortic arch surgery under deep hypothermic circulatory arrest

Cited by 36 publications

References 25 publications

Potentially Modifiable Risk Factors For Acute Kidney Injury After Surgery on The Thoracic Aorta

Potentially Modifiable Risk Factors For Acute Kidney Injury After Surgery on The Thoracic Aorta

Prognostic Implications of Acute Renal Failure after Surgery for Type A Acute Aortic Dissection

Cardiac catheterization within 1 to 3 days of proximal aortic surgery is not associated with increased postoperative acute kidney injury

Contact Info

Product

Resources

About