Surgical and early outcomes for Type A aortic dissection with preoperative renal dysfunction stratified by estimated glomerular filtration rate

Zhou, Tianyu; Li, Jun; Sun, Yongxin; Gu, Jin; Zhu, Kai; Wang, Yulin; Lai, Hao; Wang, Chunsheng

doi:10.1093/ejcts/ezy157

Cited by 13 publications

(9 citation statements)

References 24 publications

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“…To compare ND and no ND groups, Cox regression analysis was conducted, and adjusted hazard ratio (HR) and P value were reported. Apart from stroke, covariates entered in this model were age, gender, peripheral arterial disease, ejection fraction under 30%, chronic lung disease, renal function, preoperative critical state, ATAD and high extracorporeal circulation (ECC) time, as these factors are known to be associated with increased postoperative mortality after aortic surgery (2,(12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for impaired neurological outcome after thoracic aortic surgery

Demal¹,

Sitzmann²,

Bax³

et al. 2022

J Thorac Dis

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Background: We aimed to identify risk factors for an impaired postoperative neurological outcome after thoracic aortic surgery.Methods: Data from all patients undergoing thoracic aortic surgery between 2010 and 2020 at our institution were collected and analyzed retrospectively. Logistic regression analysis was used to identify independent risk factors for permanent postoperative neurological deficit (ND) (stroke), which was defined as a ND lasting at least seven days.Results: Thoracic aortic surgery was performed in 1,334 patients. Of these, 286 (21.4%) underwent emergency surgery. The mean EuroSCORE II was 8.6±10.1. A perioperative stroke occurred in 94 patients (7.0%). Of all strokes, 62.8% (n=59) were considered of embolic and 24.5% (n=23) of hemodynamic origin.In elective procedures, stroke rates ranged from 0.5% after valve-sparing root replacement to 8.1% after arch surgery. Adjusted logistic regression identified advanced age [>70 years; odds ratio (OR), 1.83; P=0.009], acute type A dissection (ATAD) (OR, 1.69; P=0.0495), aortic arch surgery (OR, 3.24; P<0.001), concomitant coronary artery bypass grafting (CABG) (OR, 2.19; P=0.005), and high extracorporeal circulation (ECC) time (>230 min; OR, 1.70; P=0.034) as independent risk factors for all strokes. Secondary endpoint analyses revealed that risk factors for hemodynamic stroke were arch surgery, advanced age (>70 years), atherosclerosis, and ATAD. Risk factors for embolic stroke were arch surgery, concomitant CABG and preoperative cerebral malperfusion.Conclusions: Identified independent risk factors for all strokes were advanced age, ATAD, arch surgery, concomitant CABG, and high ECC time. Hemodynamic and embolic strokes show distinct risk profiles.

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Section: Discussionmentioning

confidence: 99%

Risk factors for impaired neurological outcome after thoracic aortic surgery

Demal¹,

Sitzmann²,

Bax³

et al. 2022

J Thorac Dis

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“…Further, the aforementioned study also points out some postoperative complications like deep sternal wound infection, pneumonia, and tracheostomy in old age patients which are not emphasized in this study. Similarly, a study by Zhou et al 3 demonstrates that renal replacement therapy and prolonged ventilation requiring tracheotomy were prevalent complications in patients who underwent TAR with preoperative renal dysfunction.…”

mentioning

confidence: 90%

“…In a study by Kenji Okada et al 2 and demonstrated that patients with lower categories of eGFR had considerably different outcomes than higher ones. Another study conducted in 2018 3 had the same approach. Second, the authors excluded the patients with dialysis-dependent end-stage renal disease without stating the relevant reason.…”

mentioning

confidence: 99%

Letter to the editor regarding “Total arch replacement in patients with chronic kidney disease”

Ahmed

Ibrahim

Chaudhry

2022

Journal of Cardiac Surgery

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To the Editor, It was a great pleasure to read your article "Total arch replacement in patients with chronic kidney disease" by Kohei Hachiro et al. 1 in which authors determined the role of preoperative renal dysfunction on postoperative outcomes in patients undergoing elective isolated total arch replacement (TAR). The article was very well put, and the authors did a great job, but we have a few concerns that we would like to share.

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“…In those 46 patients who develop AKI, 12 (26.1%) of them had AKI before TEVAR, and 34 (73.9%) of them developed AKI after the procedure, including 39 (15.2%) in stage I, 4 (1.6%) in stage II, and 3 (1.2%) in stage III. The mean age of the patients was 52.8 ± 9.8 years, 217 (84.9%) were male, 228 (89%) were young and middle-aged people (age 65 years), 201 (78.8%) had a history of hypertension, and the median time elapsed from symptom onset to hospital admission was 7 days (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Compared to the non-AKI group, patients in the AKI group were more likely to have a higher proportion of the youth, have a higher level of body mass index (BMI), shorter time from onset to admission.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

“…The common risk factors for the occurrence of AKI in TAAD patients and TBAD patients include baseline renal function, blood pressure, renal artery involvement, etc. [3,[10][11][12]. The risk factors of AKI for patients who underwent surgery for TAAD include perioperative sepsis, extracorporeal circulation time, and postoperative 72-h drainage volume, etc.…”

Section: Introductionmentioning

confidence: 99%

Risk factors of acute kidney injury in patients with Stanford type B aortic dissection involving the renal artery who underwent thoracic endovascular aortic repair

Guo

et al. 2021

Renal Failure

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Background: Acute kidney injury (AKI) is one of the most common and serious complications in patients with type B aortic dissection (TBAD). This study aimed at investigating the incidence and risk factors of in-hospital AKI in TBAD patients involving the renal artery who underwent thoracic endovascular aortic repair (TEVAR) only. Methods: A total of 256 patients who were diagnosed as TBAD combined with renal artery involvement were included in this retrospective study. All patients were divided into the AKI group and the non-AKI group according to the KDIGO criteria. The risk factors for AKI were identified using a multivariate logistic regression model. Results: A total of 256 patients were included in this study, and the incidence of AKI was 18% (46/256). Patients in the AKI group were more likely to have a higher proportion of the youth, a higher level of body mass index, and a shorter time from onset to admission. Multivariate logistic regression analysis revealed that the youth (age 40 years) (OR: 2.853, 95%CI: 1.061-7.668, p ¼ .038) were prone to AKI, and lower estimated glomerular filtration rate (eGFR) (OR: 1.526, per 15-ml/min/1.73 m 2 decrease, 95%CI: 1.114-2.092; p ¼ .009), higher diastolic blood pressure (DBP) (OR: 1.418, per 10-mmHg increase; 95%CI: 1.070-1.879; p ¼ .015), and fasting blood glucose (FBG) 7 mmol/L on admission (OR: 2.592; 95%CI: 1.299-5.174; p ¼ .007) were independent risk factors for AKI. Conclusions: Higher incidence of AKI had been perceived in this study, most of them were young and middle-aged patients. Renopreventive measures should be considered in those highrisk patients with younger age, lower eGFR, higher DBP, and higher FBG on admission.

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Surgical and early outcomes for Type A aortic dissection with preoperative renal dysfunction stratified by estimated glomerular filtration rate

Cited by 13 publications

References 24 publications

Risk factors for impaired neurological outcome after thoracic aortic surgery

Risk factors for impaired neurological outcome after thoracic aortic surgery

Letter to the editor regarding “Total arch replacement in patients with chronic kidney disease”

Risk factors of acute kidney injury in patients with Stanford type B aortic dissection involving the renal artery who underwent thoracic endovascular aortic repair

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