Acute Kidney Injury After Total Arch Replacement Combined With Frozen Elephant Trunk Implantation: Incidence, Risk Factors, and Outcome

Zhou, Hui; Wang, Guyan; Yang, Ling; Shi, Sheng; Li, Jun; Wang, Meng; Zhang, Congya; Li, Hongyan; Qian, Xiangyang; Sun, Xiaogang; Chang, Qiang; Yu, Cuntao

doi:10.1053/j.jvca.2018.02.026

Cited by 50 publications

(45 citation statements)

References 30 publications

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“…The analysis of our present cohort of AAD patients with severe post-operation hyperbilirubinemia showed an overall incidence of post-operation AKI of 81.9%, a requirement for CRRT of 18.5%, and the in-hospital mortality increased from 14 % in all patients to 30.3% in those with post-operative hyperbilirubinemia. In previous studies of AAD patients underwent surgical treatment without severe post-operation hyperbilirubinemia, the reported AKI incidences were ranged from 40% to 78%, [17][18][19][20][21][22][23][24][25] the reported incidences of requirement for CRRT were ranged from 3% to 8%, [21,25] and the reported in-hospital mortalities were ranged from 15% to 26%. [18,21,[25][26][27] The discrepancy most likely attributed to the fact that all of the included AAD patients in our study developed severe hyperbilirubinemia.…”

Section: Aad Patients With Severe Hyperbilirubinemia Were Associated mentioning

confidence: 99%

Characteristics and outcomes of Stanford type A aortic dissection patients with severe post-operation hyperbilirubinemia: a retrospective cohort study

Chen

Bai

Zhao

et al. 2020

Preprint

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Abstract Background: Hyperbilirubinemia is one of the common complications after cardiac surgery and is associated with increased mortality. However, to the best of our knowledge, the reports on clinical significance of postoperative severe hyperbilirubinemia in Stanford type A aortic dissection (AAD) patients were limited. Methods: Patients who underwent surgical treatment for AAD in our center between January 2015 and December 2018 were retrospectively screened. In-hospital mortality, long-term mortality, acute kidney injury (AKI), and the requirement of continuous renal replacement therapy (CRRT) were assessed as endpoints. Univariate and multivariate regression models were employed to identify the risk factors of these endpoints. Results: After screening, 271 patients were included in our present study. Of the included patients, 222 (81.9%) experienced postoperative AKI, and 50 (18.5%) received CRRT. The in-hospital mortality was 30.3%. The 1-year, 2-year, and 3-year cumulative mortality were 32.9%, 33.9%, and 35.3%, respectively. Multivariate Logistic regression analysis indicated that age (P < 0.033), AKI stage 3 (P < 0.001), the amount of blood transfusion after surgery (P = 0.019), mean arterial pressure (MAP) in the first postoperative day (P = 0.012), the use of extracorporeal membrane oxygenation (ECMO) (P = 0.02), and the peak total bilirubin (TB) concentration (P = 0.023) were independent risk factors of in-hospital mortality. The optimal cut-off value of peak TB on predicting in-hospital mortality was 121.2 μmol/L. Patients with post-operation TB ≥ 121 μmol/L was associated with worse long-term survival as well. Conclusions: Severe post-operation hyperbilirubinemia is a common clinical situation in patients had AAD repair. In AAD patients with severe post-operation hyperbilirubinemia, older age, lower MAP, increased blood transfusion, stage 3 AKI, the use of ECMO, and the increased peak TB lead to increase in-hospital mortality.

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Section: Aad Patients With Severe Hyperbilirubinemia Were Associated mentioning

confidence: 99%

Characteristics and outcomes of Stanford type A aortic dissection patients with severe post-operation hyperbilirubinemia: a retrospective cohort study

Chen

Bai

Zhao

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…The analysis of our present cohort of AAD patients with post-operation severe hyperbilirubinemia showed an overall incidence of post-operation AKI of 81.9%, a requirement for CRRT of 18.5%, and the in-hospital mortality rate of 30.3%. In previous studies of AAD patients underwent surgical treatment without post-operation severe hyperbilirubinemia, the reported AKI incidences were ranged from 40-78%, [5][6][7][18][19][20][21][22][23] the reported incidences of requirement for CRRT were ranged from 3% to 8%, [5,7] and the reported in-hospital mortalities were ranged from 15-26%. [4,5,7,19,24] The discrepancy most likely attributed to the fact that all of the included AAD patients in our study developed severe hyperbilirubinemia.…”

Section: Aad Patients With Severe Hyperbilirubinemia Were Associated mentioning

confidence: 99%

Characteristics and outcomes of Stanford type A aortic dissection patients with post-operation severe hyperbilirubinemia: a retrospective cohort study

Chen

Bai

Zhao

et al. 2020

Preprint

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Objective Hyperbilirubinemia is one of the common complications after cardiac surgery and is associated with increased mortality. However, to the best of our knowledge, the report on clinical significance of postoperative severe hyperbilirubinemia in Stanford type A aortic dissection (AAD) patients is limited. Therefore, the purpose of our present study is to assess the characteristics and outcomes of AAD patients with post-operation severe hyperbilirubinemia.Methods Patients who underwent surgical treatment for AAD in our center between January 2015 and December 2018 were retrospectively screened. In-hospital mortality, long-term mortality, acute kidney injury (AKI), and the requirement of continuous renal replacement therapy (CRRT) were assessed as endpoints. Univariate and multivariate regression models were employed to identify the risk factors of these endpoints.Results Of the 2210 screened patients, 271 (12.3%) were included. Of the included patients, 222 (81.9%) experienced postoperative AKI, and 50 (18.5%) received CRRT. In-hospital mortality was 30.3%. The 1-year, 2-year, and 3-year cumulative mortality were 32.9%, 33.9%, and 35.3%, respectively. Multivariate Logistic regression analysis indicated that age ( P < 0.033), AKI stage 3 ( P < 0.001), the total amount of blood transfusion after surgery ( P = 0.019), mean arterial pressure (MAP) in the first postoperative day ( P = 0.012), the use of extracorporeal membrane oxygenation (ECMO) after surgery ( P = 0.02), and the peak total bilirubin (TB) concentration ( P = 0.023) were independent risk factors of in-hospital mortality. The optimal cut-off value of peak TB on predicting in-hospital mortality was 121.2 μmol/l. Older age, high preoperative serum creatinine (SCr) concentration, and prolonged cardiopulmonary bypass (CPB) time were identified as the independent risk factors of AKI. High preoperative SCr concentration was identified as the only independent risk factor of the requirement of CRRT.Conclusions Post-operation severe hyperbilirubinemia is a common clinical presentation in AAD surgery patients. Post-operation severe hyperbilirubinemia AAD patients with older age, lower MAP, increased blood transfusion, stage 3 AKI, the use of ECMO, and the increased peak TB had higher risk of in-hospital mortality.

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“…Open total aortic arch replacement is characterized by a long intraoperative duration and extended hypothermic circulatory arrest time. The incidence of AKI in patients is significantly higher following open total aortic arch replacement than following other cardiac surgical procedures, reaching as high as 77.6% according to our previous retrospective analysis [2]. The therapeutic options for AKI following open total aortic arch replacement remain a significant challenge.…”

Section: Introductionmentioning

confidence: 95%

“…The sample size of the previous clinical trial of 7-days post operation was based on our retrospective cohort study [2], we estimated that 75% of participants in the sham group would develop into AKI after surgery. The expected absolute risk reduction for AKI was 25% according to the result of the pilot study.…”

Section: Statistical Analysis Of the Datamentioning

confidence: 99%

90 days impacts of remote ischemic preconditioning on patients undergoing open total aortic arch replacement: a post-hoc analysis of previous trial

et al. 2020

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Background: In the previous randomized controlled trial by our research group, we evaluated the effect of remote ischemic preconditioning (RIPC) in 130 patients (65 per arm) on acute kidney injury (AKI) within 7 days of open total aortic arch replacement. Significantly fewer RIPC-treated patients than sham-treated patients developed postoperative AKI, and, epically, RIPC significantly reduced serious AKI (stage II-III). However, the long-term effect of RIPC in patients undergoing open total aortic arch replacement is unclear. Methods: This study was a post-hoc analysis. We aimed to assess the roles of RIPC in major adverse kidney events (MAKE), defined as consisting persistent renal dysfunction, renal replacement therapy and mortality, within 90 days after surgery in patients receiving open total aortic arch replacement. Results: In this 90-day follow-up study, data were available for all study participants. We found that RIPC failed to improve the presence of MAKE within 90 days after surgery (RIPC: 7 of 65[10.8%]) vs sham: 15 of 65[23.1%]; P = 0.061). In those patients who developed AKI after surgery, we found that the rate of MAKE within 90 days after surgery differed between the RIPC group and the sham group (RIPC: 4 of 36[11.2%]; sham: 14 of 48[29.2%]; P = 0.046). Conclusions: At 90 days after open total aortic arch replacement, we failed to find a difference between the renoprotective effects of RIPC and sham treatment. The effectiveness or ineffectiveness of RIPC should be further investigated in a large randomized sham-controlled trial. Trial registration: This study was approved by the Ethics Committee of Fuwai Hospital (No. 2016-835) and our previous study was registered at clinicaltrials.gov before patient enrollment (NCT03141385; principal investigator: G.W.; date of registration: March 5, 2017).

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Acute Kidney Injury After Total Arch Replacement Combined With Frozen Elephant Trunk Implantation: Incidence, Risk Factors, and Outcome

Cited by 50 publications

References 30 publications

Characteristics and outcomes of Stanford type A aortic dissection patients with severe post-operation hyperbilirubinemia: a retrospective cohort study

Characteristics and outcomes of Stanford type A aortic dissection patients with severe post-operation hyperbilirubinemia: a retrospective cohort study

Characteristics and outcomes of Stanford type A aortic dissection patients with post-operation severe hyperbilirubinemia: a retrospective cohort study

90 days impacts of remote ischemic preconditioning on patients undergoing open total aortic arch replacement: a post-hoc analysis of previous trial

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