Clinical Predictors for Prolonged Intensive Care Unit Stay in Adults Undergoing Thoracic Aortic Surgery Requiring Deep Hypothermic Circulatory Arrest

Augoustides, John; Pochettino, Alberto; Ochroch, E. Andrew; Cowie, Doreen; McGarvey, Michael L.; Weiner, Jeff L.; Gambone, Andrew J.; Pinchasik, Dawn; Cheung, Albert T.; Bavaria, Joseph E.

doi:10.1053/j.jvca.2005.07.031

Cited by 37 publications

(29 citation statements)

References 45 publications

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“…Although several reports have documented the independent association between AKI and mortality in aortic surgery [3,14,15], no significant difference in mortality was observed in the present study, probably because the mortality rate was low and the number of patients might not be large enough to detect a difference in mortality.…”

Section: Discussioncontrasting

confidence: 88%

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

et al. 2011

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Section: Discussioncontrasting

confidence: 88%

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

et al. 2011

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“…Although the incidence of postoperative AKI (31%) in our study appears higher than in the comparable studies of CABG or valve surgery (6-11), it is similar to the AKI rates reported in prior studies of complex thoracic aortic operations (1-4). However, the incidence of dialysis (1.1%) in our study remained low, consistent with the expected rates of dialysis in low-risk patients undergoing elective operation.…”

Section: Discussionsupporting

confidence: 78%

“…However, the incidence of dialysis (1.1%) in our study remained low, consistent with the expected rates of dialysis in low-risk patients undergoing elective operation. Although AKI is an established risk factor for mortality following cardiac and thoracic aortic operations (1-4, 11), our study is underpowered to re-demonstrate this association in multivariable models given that only five (1.8%) postoperative deaths occurred. Nonetheless, it is assumed from prior studies that postoperative AKI leads to worse patient outcomes, and aggressive efforts should be taken to minimize AKI in the perioperative period.…”

Section: Discussionmentioning

confidence: 90%

“…Acute kidney injury (AKI) occurs in 18–48% of patients following thoracic aortic surgery and is associated with increased hospital costs, length of stay, and mortality (1-4). Cardiac catheterization is routinely performed prior to elective surgery of the proximal thoracic aorta to define aortic root and coronary anatomy and screen for coronary artery disease requiring concomitant intervention (5).…”

Section: Introductionmentioning

confidence: 99%

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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

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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.

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“…1, 2 In this setting, exposure to the cardiopulmonary bypass (CPB) circuit, abrupt alterations in body temperature and whole-body ischemia/reperfusion (I/R) lead to profound perturbations in inflammatory, hemostatic, and oxidative stress pathways, all implicated in the pathogenesis of an often pronounced systemic inflammatory response syndrome (SIRS). This perioperative SIRS has been associated with hemodynamic instability, bleeding disorders, and myocardial, respiratory, renal, and cognitive dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Intestinal Mast Cells Mediate Gut Injury and Systemic Inflammation in a Rat Model of Deep Hypothermic Circulatory Arrest*

Karhausen

Gibson

et al. 2013

Critical Care Medicine

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Background Cardiac surgery, especially when employing cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA), is associated with systemic inflammatory responses that significantly affect morbidity and mortality. Intestinal perfusion abnormalities have been implicated in such responses, but the mechanisms linking local injury and systemic inflammation remain unclear. Intestinal mast cells (MC) are specialized immune cells that secrete various preformed effectors in response to cellular stress. We hypothesized that MCs are activated in a microenvironment shaped by intestinal ischemia/reperfusion (I/R), and investigated local and systemic consequences in a rat model of DHCA. Methods and Results Adult rats were cooled to 16-18°C on CPB before instituting DHCA for 45 minutes. Specimens were harvested following rewarming and 2 hours of recovery. Significant intestinal barrier disruption was found, together with macro- and microscopic evidence of I/R injury in ileum and colon but not in lungs or kidneys. Immunofluorescence and toluidine blue staining revealed MC hyperplasia and activation in the gut. Pretreatment with the MC stabilizer cromolyn sodium efficiently blocked MC degranulation and resulted in preserved intestinal morphology and barrier function following DHCA. Furthermore, cromolyn sodium treatment dramatically reduced intestinal neutrophil influx and systemic release of various proinflammatory cytokines. Conclusions Our data provides primary evidence that intestinal I/R is a leading pathophysiologic process in a rat model of DHCA and that intestinal injury and local and systemic inflammatory responses are critically dependent on MC activation. This identifies intestinal MCs as central players in DHCA-associated responses, and opens novel therapeutic possibilities for patients undergoing this procedure.

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Clinical Predictors for Prolonged Intensive Care Unit Stay in Adults Undergoing Thoracic Aortic Surgery Requiring Deep Hypothermic Circulatory Arrest

Cited by 37 publications

References 45 publications

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

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

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

Intestinal Mast Cells Mediate Gut Injury and Systemic Inflammation in a Rat Model of Deep Hypothermic Circulatory Arrest*

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