Acute Kidney Injury After Acute Repair of Type A Aortic Dissection

Helgason, Daði; Helgadóttir, Sólveig; Ahlsson, Anders; Gunn, Jarmo; Hjortdal, Vibeke E.; Hansson, Emma C.; Jeppsson, Anders; Mennander, Ari; Nozohoor, Shahab; Zindovic, Igor; Olsson, Christian; Ragnarsson, Stefan Orri; Sigurdsson, Martin I.; Geirsson, Arnar; Guðbjartsson, Tómas

doi:10.1016/j.athoracsur.2020.07.019

Cited by 57 publications

(118 citation statements)

References 24 publications

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“…Our study showed that severe postoperative hypoxemia would negatively impact clinical outcomes, including higher RRT usage, longer LOS of ICU, and shorter 28 days VFDs. The incidence of AKI, which manifests through rapid loss of renal function with high morbidity and mortality (18), remained high in such a population (19,20). The postoperative low oxygen supply and high oxygen might play a vital role in this progression (21).…”

Section: Discussionmentioning

confidence: 99%

Independent risk factors of hypoxemia in patients after surgery with acute type A aortic dissection

Zhou¹,

Pan²,

Yu³

et al. 2021

Ann Palliat Med

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Background: This study aimed to investigate independent risk factors of postoperative hypoxemia in patients with acute type A aortic dissection (ATAAD).Methods: A single-center retrospective study was conducted with enrolled 75 ATAAD patients following surgery, which were stratified into three groups on the basis of the postoperative PaO 2 /FiO 2 ratio: severe hypoxemia group (PaO 2 /FiO 2 ratio ≤100 mmHg); moderate hypoxemia group (100 mmHg < PaO 2 /FiO 2 ratio ≤200 mmHg); and non-hypoxemia group (PaO 2 /FiO 2 ratio >200 mmHg). The patient's demography, perioperative laboratory results, operative details, clinical outcomes were collected and analyzed. Univariable and multivariable analyses were performed and logistic regression model was established. Results:The incidence of postoperative severe hypoxemia and hypoxemia was 32% and 52%, respectively. Among the three groups, severe hypoxemia group exhibited a high significance of body mass index (BMI) and preoperative white blood cell (WBC) and main distribution of hypertension; meanwhile, Marfan syndrome was mainly distributed in non-hypoxemia group. On intensive care unit (ICU) admission, severe hypoxemia group exhibited a high significance of Acute Physiology and Chronic Health Evaluation (APACHE II) score of postoperative patients, and more patients would present shock. Moreover, severe hypoxemia group patients had a higher incidence of postoperative acute kidney injury (AKI) and usage of renal replacement therapy, longer length of stay (LOS) of ICU, and shorter 28 days ventilator-free days (VFDs). Conclusions:The incidence of postoperative hypoxemia was high in ATAAD patients owing to comprehensive high-risk factors. Besides, postoperative complications negatively impacted their clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Independent risk factors of hypoxemia in patients after surgery with acute type A aortic dissection

Zhou¹,

Pan²,

Yu³

et al. 2021

Ann Palliat Med

View full text Add to dashboard Cite

show abstract

“…Patients with kidney disease may have more extensive coronary disease preoperatively, along with other comorbidities. Besides, impaired renal function can be a direct risk factor for intra-and postoperative complications, due to the need for greater fluid infusions or blood transfusions [16,17,18]. Having chronic kidney insufficiency on admission in our study was associated with both early postoperative complications and lethal outcome.…”

Section: Discussionmentioning

confidence: 63%

“…Pre-and postoperative renal complications are risk factors for increased mortality in patients with acute AD type A [16]. The association between renal disease and worse cardiac surgery outcomes has multiple explanations [17]. Patients with kidney disease may have more extensive coronary disease preoperatively, along with other comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing early surgical outcomes of patients with acute aortic dissection type A

et al. 2021

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Introduction/Objective. Even with the current treatment mortality from aortic dissection remains high. The study aimed to evaluate the early postoperative outcome of patients with aortic dissection and identify which factors could have influence on it. Methods. The study included all consecutive patients who underwent surgery for acute aortic dissection type A from 2012 to 2017. We registered all parameters that could potentially impact the outcome (general data, medical history, clinical and cardiological diagnostic test findings, preoperative complications, type of cannulation and the operation performed, additional surgical procedures, operation duration, etc.). Patients were surgically treated according to the current protocols. The main outcome measures were complications and mortality during a one-month postoperative period. All data collected pre-, intra-, and postoperatively were compared and statistically analyzed. Results. The study included 246 patients, of an average 57.54+/-12.88 years of age and mostly male sex (74%). Early postoperative mortality occurred in 17% of patients. Preoperative chronic kidney insufficiency (p = 0.005) and cerebrovascular insult (p = 0.047) and tamponade (p = 0.036) were the major risk factors for postoperative complications and mortality. Long hypothermic cardiac arrest (p = 0.001), cross clamp (p = 0.017) and cardiopulmonary bypass time (p = 0.036) increased postoperative complications. Postoperative complications started occurring after ?33.5 minutes hypothermic cardiac arrest and ?67.5 minutes cross clamp time. Having more postoperative complications (p = 0.034) increased, while performing anterograde cerebral perfusion decreased the frequency of lethal outcome (p = 0.001). Conclusion. The majority of patients surgically treated for acute aortic dissection had good postoperative outcome. However, numerous pre-, intra- and postoperative factors can impact patient survival.

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“…A more recent analysis of the Society of Thoracic Surgeon database including 7353 patients operated from 2014 and 2017 for acute TAAD reported a 30-day mortality of 17% [ 5 ]. Furthermore, surgery for TAAD is often complicated by major adverse events such as stroke [ 5 ] and acute kidney failure [ 6 ], which may have a significant impact on late survival. In this scenario of significant postoperative mortality and morbidity, surgeon faces the controversial issue of the extent of surgical repair for acute TAAD by avoiding a major surgical repair, which may increase the risk of early adverse events, and by resecting segments of the aorta which otherwise may expose the patient to the risk of late aortic-related complications [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

European registry of type A aortic dissection (ERTAAD) - rationale, design and definition criteria

Biancari

Mariscalco

Yusuff

et al. 2021

J Cardiothorac Surg

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Background Acute Stanford type A aortic dissection (TAAD) is a life-threatening condition. Surgery is usually performed as a salvage procedure and is associated with significant postoperative early mortality and morbidity. Understanding the patient’s conditions and treatment strategies which are associated with these adverse events is essential for an appropriate management of acute TAAD. Methods Nineteen centers of cardiac surgery from seven European countries have collaborated to create a multicentre observational registry (ERTAAD), which will enroll consecutive patients who underwent surgery for acute TAAD from January 2005 to March 2021. Analysis of the impact of patient’s comorbidities, conditions at referral, surgical strategies and perioperative treatment on the early and late adverse events will be performed. The investigators have developed a classification of the urgency of the procedure based on the severity of preoperative hemodynamic conditions and malperfusion secondary to acute TAAD. The primary clinical outcomes will be in-hospital mortality, late mortality and reoperations on the aorta. Secondary outcomes will be stroke, acute kidney injury, surgical site infection, reoperation for bleeding, blood transfusion and length of stay in the intensive care unit. Discussion The analysis of this multicentre registry will allow conclusive results on the prognostic importance of critical preoperative conditions and the value of different treatment strategies to reduce the risk of early adverse events after surgery for acute TAAD. This registry is expected to provide insights into the long-term durability of different strategies of surgical repair for TAAD. Trial registration ClinicalTrials.gov Identifier: NCT04831073.

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Acute Kidney Injury After Acute Repair of Type A Aortic Dissection

Cited by 57 publications

References 24 publications

Independent risk factors of hypoxemia in patients after surgery with acute type A aortic dissection

Independent risk factors of hypoxemia in patients after surgery with acute type A aortic dissection

Factors influencing early surgical outcomes of patients with acute aortic dissection type A

European registry of type A aortic dissection (ERTAAD) - rationale, design and definition criteria

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