Perioperative Management of the Patient at High-Risk for Cardiac Surgery-Associated Acute Kidney Injury

Milne, Benjamin; Gilbey, Tom; Kunst, Gudrun

doi:10.1053/j.jvca.2022.08.016

Cited by 13 publications

(18 citation statements)

References 269 publications

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“…Preoperative assessment and optimisation are mandatory to be done. Avoiding nephrotoxic medication especially nonsteroidal anti-inflammatory drugs and angiotensin converting enzyme inhibitors, maintaining adequate volume status, using a responsible management of the contrast in preoperative imagistic evaluation may be some actions [ 12 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…The multidisciplinary team must avoid the hemodynamic instability and manage the low cardiac output states, rationally using the vasopressors and inotropes. Hypovolemia, anaemia and vasoplegia must be also addressed in order to optimise the arterial renal perfusion of the remaining kidney [ 26 ]. The increased renal after load must be also avoided using appropriate lung ventilation with optimised peep, diuresis, ultrafiltration [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hypovolemia, anaemia and vasoplegia must be also addressed in order to optimise the arterial renal perfusion of the remaining kidney [ 26 ]. The increased renal after load must be also avoided using appropriate lung ventilation with optimised peep, diuresis, ultrafiltration [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

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AKI3-Risk Predictors and Scores in Radical Nephrectomy with High Thrombectomy under Extracorporeal Circulation for Renal Cell Carcinoma with Supradiaphragmatic Inferior Vena Cava/Right Atrial Thrombus: A Single-Centre Retrospective Study

Drăgan¹,

Sinescu

2023

Medicina

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Background and Objectives: The recommended therapeutic management in renal cell carcinoma (RCC) with supradiaphragmatic inferior vena cava/right atrial thrombus (IVC/RA) is surgery. Extracorporeal circulation is required. Acute kidney injury (AKI), a frequent complication after nephrectomy and cardiac surgery is associated with long-term kidney disease. This study aims to identify the risk factors involved in the occurrence of the severe postoperative AKI (AKI3) and to analyse various preoperative validated risk scores from cardiac and noncardiac surgery in predicting this endpoint. Materials and Methods: The medical data of all patients with RCC with supradiaphragmatic IVC/RA thrombus who underwent radical nephrectomy with high thrombectomy, using extracorporeal circulation, between 2004–2018 in the Prof. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, were retrospectively analysed. The patients who died intraoperatively were excluded from the study. The predefined study endpoint was the postoperative AKI3. Preoperative, intraoperative and postoperative data were collected according to the stratification of study population in two subgroups: AKI3-present and AKI3- absent patients. EuroSCORE, EuroSCORE II, Logistic EuroSCORE, NSQIP any-complications and NSQIP serious-complications were analysed. Results: We reviewed 30 patients who underwent this complex surgery between 2004–2018 in our institute. Two patients died intraoperatively. Nine patients (32.14%) presented postoperative AKI3. Age (OR 1.151, CI 95%: 1.009–1.312), preoperative creatinine clearance (OR 1.066, CI 95%: 1.010–1.123) and intraoperative arterial hypotension (OR 13.125, CI 95%: 1.924–89.515) were risk factors for AKI3 (univariable analysis). Intraoperative arterial hypotension emerged as the only independent risk factor in multivariable analysis (OR 11.66, CI 95%: 1.400–97.190). Logistic EuroSCORE (ROC analysis: AUC = 0.813, p = 0.008, CI 95%: 0.633–0.993) best predicted the endpoint. Conclusions: An integrated team effort is essential to avoid intraoperative arterial hypotension, the only independent risk factor of AKI3 in this highly complex surgery. Some risk scores can predict this complication. Further studies are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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AKI3-Risk Predictors and Scores in Radical Nephrectomy with High Thrombectomy under Extracorporeal Circulation for Renal Cell Carcinoma with Supradiaphragmatic Inferior Vena Cava/Right Atrial Thrombus: A Single-Centre Retrospective Study

Drăgan¹,

Sinescu

2023

Medicina

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“…In addition, the introduction of new surgical devices can help reduce aortic cross clamp time, and avoid the dissection of a previous aortotomy site and annulus injury during hand-tying. Moreover, the postoperative cardiac intensive care protocols have been developed and standardized (30).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Recent Outcomes of Surgical Redo Aortic Valve Replacement in Prosthetic Valve Failure

Kang,

Soehartono,

Choi

et al. 2024

Thorac Cardiovasc Surg

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Background. As redo surgical aortic valve replacement(AVR) is relatively high risk, valve-in-valve transcatheter AVR has emerged as an alternative for failed prostheses. However, the majority of studies are outdated. This study assessed the current clinical outcomes of redo AVR. Methods and Results. This study enrolled 324 patients who underwent redo AVR due to prosthetic valve failure from 2010 to 2021 in four tertiary centers. The primary outcome was operative mortality. The secondary outcomes were overall survival, cardiac death, and aortic valve-related events. Logistic regression analysis, clustered Cox proportional hazards models, and competing risk analysis were used to evaluate the independent risk factors. Redo AVR was performed in 242 patients without endocarditis and 82 patients with endocarditis. Overall operative mortality was 4.6% (15 deaths). Excluding patients with endocarditis, the operative mortality of redo AVR decreased to 2.5%. Multivariate analyses demonstrated that endocarditis (HR 3.990, P=0.014), longer cardiopulmonary bypass time (HR 1.006, P=0.037) and lower left ventricular ejection fraction (LVEF) (HR 0.956, P=0.034) were risk factors of operative mortality. Endocarditis and lower LVEF were independent predictors of overall survival. Conclusions. The relatively high risk of redo AVR was due to reoperation for prosthetic valve endocarditis. The outcomes of redo AVR for non-endocarditis are excellent. Our findings suggest that patients without endocarditis, especially with acceptable LVEF, can be treated safely with redo AVR.

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“…Consensus across subspecialties exists for personalized care in response to biomarkers, 31 and various experts have already included biomarkers in standardized AKI management guidelines for cardiac surgery. 32 Others are likely to follow. Finally, many authors seem confused by how the costs of diagnostic tests fit into the health care landscape and who pays for them.…”

Section: Clinical Experiencementioning

confidence: 99%

Do Novel Biomarkers Have Utility in the Diagnosis and Prognosis of AKI? PRO

Kellum¹,

Goldstein

2023

Kidney360

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Perioperative Management of the Patient at High-Risk for Cardiac Surgery-Associated Acute Kidney Injury

Cited by 13 publications

References 269 publications

AKI3-Risk Predictors and Scores in Radical Nephrectomy with High Thrombectomy under Extracorporeal Circulation for Renal Cell Carcinoma with Supradiaphragmatic Inferior Vena Cava/Right Atrial Thrombus: A Single-Centre Retrospective Study

AKI3-Risk Predictors and Scores in Radical Nephrectomy with High Thrombectomy under Extracorporeal Circulation for Renal Cell Carcinoma with Supradiaphragmatic Inferior Vena Cava/Right Atrial Thrombus: A Single-Centre Retrospective Study

Recent Outcomes of Surgical Redo Aortic Valve Replacement in Prosthetic Valve Failure

Do Novel Biomarkers Have Utility in the Diagnosis and Prognosis of AKI? PRO

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