scholarly journals Lower body ischaemic time is a risk factor for acute kidney injury after surgery for type A acute aortic dissection

2019 ◽  
Vol 30 (1) ◽  
pp. 107-112 ◽  
Author(s):  
Kentaro Amano ◽  
Yoshiyuki Takami ◽  
Hiroshi Ishikawa ◽  
Michiko Ishida ◽  
Masato Tochii ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Surgical Repair ◽  
Kidney Injury ◽  
Type A ◽  
Hospital Death ◽  
Lower Body ◽  
Postoperative Aki

Abstract OBJECTIVES Postoperative acute kidney injury (AKI) is known as a risk factor for death after surgery for Stanford type A acute aortic dissection under hypothermic circulatory arrest. It may also adversely affect long-term survival. We searched for modifiable risk factors for postoperative AKI, focusing on lower body ischaemic time. METHODS We reviewed 191 patients undergoing surgical repair for Stanford type A acute aortic dissection. The distal anastomosis depended on excluding the primary tear location, resulting in ascending/hemiarch (n = 119), partial arch (n = 18) and total arch replacement (n = 54). We defined an increase in the serum creatinine level to ≧2 times the baseline level as AKI. The incidence of AKI was investigated with multivariate analysis of its risk factors. RESULTS Postoperative AKI was observed in 49 patients (26%), 31% of whom required renal replacement therapy. The overall hospital mortality rate was 8.5%. Postoperative AKI, preoperative shock and organ malperfusion were predictors of hospital death. Multivariate stepwise logistic regression analysis identified age, body mass index, preoperative chronic kidney disease and lower body ischaemic time as risk factors for postoperative AKI. CONCLUSIONS Although surgical repair for Stanford type A acute aortic dissection showed favourable results, the incidence of postoperative AKI is still high, closely associated with hospital death. Lower body ischaemic time should be recognized specifically as a modifiable surgical risk factor for postoperative AKI.

scholarly journals Impact of autologous platelet rich plasma use on postoperative acute kidney injury in type A acute aortic dissection repair: a retrospective cohort analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jiaqi Tong ◽  
Liang Cao ◽  
Liwei Liu ◽  
Mu Jin
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Cohort Analysis ◽  
Kidney Injury ◽  
Type A ◽  
Blood Transfusions ◽  
Autologous Platelet

Abstract Background Perioperative coagulopathy and blood transfusion are common in patients undergoing Stanford type A acute aortic dissection (AAD) repair. The autologous platelet-rich plasmapheresis (aPRP) technique is a blood conservation approach to reduce blood transfusions and morbidity in patients at high risk of bleeding. The purpose of this study was to analyze the effect of aPRP on outcomes, especially in postoperative acute kidney injury (post-AKI), in patients undergoing AAD surgery. Methods Six hundred sixty patients were divided into aPRP and non-aPRP groups according to aPRP use. The primary endpoint was the difference in the incidence of post-AKI between two groups. The secondary endpoints were risk factors for post-AKI and to assess clinical outcomes. The risk factors associated with post-AKI were calculated, and all outcomes were adjusted by propensity-score matching analysis. Results A total of 272 patients (41.2%) received aPRP, whereas 388 were in the non-aPRP group. Compared to non-aPRP group, the occurrence of post-AKI increased by 14.1% (p = 0.002) and 11.1% (p = 0.010) with and without propensity adjustment in the aPRP group, respectively. The aPRP group required fewer intraoperative transfusions (p < 0.05) and shortened the duration of mechanical ventilation (p < 0.05) than those in the non-aPRP group. Multiple regression analyses showed that aPRP (odds ratio: 1.729, 95% confidence interval: 1.225–2.440; p < 0.001) was one of the independent risk factors for post-AKI. Conclusions The use of aPRP significantly reduced intraoperative blood transfusions and decreased postoperative mortality-adjusted mechanical ventilation. However, aPRP use was independently associated with an increased hazard of post-AKI after adjusting for confounding factors.

scholarly journals Impact of autologous platelet rich plasma use on postoperative acute kidney injury in type A acute aortic dissection repair: A retrospective cohort analysis

2020 ◽  
Author(s):  
Jiaqi Tong ◽  
Liang Cao ◽  
Liwei Liu ◽  
Mu Jin
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Cohort Analysis ◽  
Kidney Injury ◽  
Type A ◽  
Blood Transfusions ◽  
Autologous Platelet

Abstract Backround: Perioperative coagulopathy and blood transfusion are common in patients undergoing Stanford type A acute aortic dissection (AAD) repair. The autologous platelet-rich plasmapheresis (aPRP) technique is a blood conservation approach to reduce blood transfusions and morbidity in patients at high risk of bleeding. The purpose of this study was to analyze the effect of aPRP on outcomes, especially in postoperative acute kidney injury (post-AKI), in patients undergoing AAD surgery.Methods: Six hundred sixty patients were divided into aPRP and non-aPRP groups according to aPRP use. The primary endpoint was the difference in the incidence of post-AKI between two groups. The secondary endpoints were risk factors for post-AKI and to assess clinical outcomes. The risk factors associated with post-AKI were calculated, and all outcomes were adjusted by propensity-score matching analysis.Results: A total of 272 patients (41.2%) received aPRP, whereas 388 were in the non-aPRP group. Compared to non-aPRP group, the occurrence of post-AKI increased by 14.1% (p=0.002) and 11.1% (p=0.010) with and without propensity adjustment in the aPRP group, respectively. The aPRP group required fewer intraoperative transfusions (p<0.05) and shortened the duration of mechanical ventilation (p<0.05) than those in the non-aPRP group. Multiple regression analyses showed that aPRP (odds ratio: 1.729, 95% confidence interval: 1.225–2.440; p<0.001) was one of the independent risk factors for post-AKI.Conclusions: The use of aPRP significantly reduced intraoperative blood transfusions and decreased postoperative mortality-adjusted mechanical ventilation. However, aPRP use was independently associated with an increased hazard of post-AKI after adjusting for confounding factors.

scholarly journals Impact of autologous platelet rich plasma use on postoperative acute kidney injury in type A acute aortic dissection repair: A retrospective cohort analysis

2020 ◽  
Author(s):  
Jiaqi Tong ◽  
Liang Cao ◽  
Liwei Liu ◽  
Mu Jin
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Cohort Analysis ◽  
Kidney Injury ◽  
Type A ◽  
Blood Transfusions ◽  
Autologous Platelet

Abstract Background Perioperative coagulopathy and blood transfusion are common in patients undergoing Stanford type A acute aortic dissection (AAD) repair. The autologous platelet-rich plasmapheresis (aPRP) technique is a blood conservation approach to reduce blood transfusions and morbidity in patients at high risk of bleeding. The purpose of this study was to analyze the effect of aPRP on outcomes, especially in postoperative acute kidney injury (post-AKI), in patients undergoing AAD surgery.Methods Six hundred sixty patients were divided into aPRP and non-aPRP groups according to aPRP use. The primary endpoint was the difference in the incidence of post-AKI between two groups. The secondary endpoints were risk factors for post-AKI and to assess clinical outcomes. The risk factors associated with post-AKI were calculated, and all outcomes were adjusted by propensity-score matching analysis.Results A total of 272 patients (41.2%) received aPRP, whereas 388 were in the non-aPRP group. Compared to non-aPRP group, the occurrence of post-AKI increased by 14.1% (p=0.002) and 11.1% (p=0.010) with and without propensity adjustment in the aPRP group, respectively. The aPRP group required fewer intraoperative transfusions (p<0.05) and shortened the duration of mechanical ventilation (p<0.05) than those in the non-aPRP group. Multiple regression analyses showed that aPRP (odds ratio: 1.729, 95% confidence interval: 1.225–2.440; p<0.001) was one of the independent risk factors for post-AKI. Conclusions The use of aPRP significantly reduced intraoperative blood transfusions and decreased postoperative mortality-adjusted mechanical ventilation. However, aPRP use was independently associated with an increased hazard of post-AKI after adjusting for confounding factors.

Risk Factors for Mortality in Acute Aortic Dissection Type A: A Centre Experience Over 15 Years

2020 ◽  
Author(s):  
Mohamed Salem ◽  
Christine Friedrich ◽  
Alexander Thiem ◽  
Katharina Huenges ◽  
Thomas Puehler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Mortality Rate ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Circulatory Arrest ◽  
Kidney Injury ◽  
Type A ◽  
Aortic Dissection Type A

Abstract Introduction Acute aortic dissection Type A (AADA) is still associated with a high mortality rate and frequent postoperative complications. This study was designed to evaluate the risk factors for mortality in AADA patients. Patients and Methods This retrospective analysis included 344 consecutive patients who underwent surgery for AADA in moderate hypothermic circulatory arrest (20–24°C nasopharyngeal) between 2001 and 2016. Results The 30-day mortality rate was 18%. Nonsurvivors were significantly older (65.7 ± 12.0 years vs. 62.0 ± 12.5 years; p = 0.034) with significantly higher Euro-score II [15.4% (6.6; 23.0) vs. 4.63% (2.78; 9.88); p < 0.001)]. Intraoperatively, survivors had statistically shorter cardiopulmonary bypass times [163 (134; 206) vs. 198 min (150; 245); p = 0.001]. However, the hypothermic circulatory arrest time was similar between both groups. Postoperatively, the incidence of acute kidney injury (AKI) (55.9 vs. 15.2%; p < 0.001), stroke (27.9 vs. 12.1%; p = 0.002) and sepsis (18.0 vs. 2.1%; p < 0.001) were significantly higher among nonsurvivors. The multi-variable logistic regression confirmed that older age, previous cardiac surgery, preoperative cardiopulmonary resuscitation (CPR), blood transfusion and postoperative acute kidney injury (AKI) were independent risk factors for mortality. Conclusion Our analysis suggested that the reason for mortality was multifactorial, especially age, previous cardiac surgery, CPR, transfusion, as well as postoperative AKI were considered risk factors for mortality.

scholarly journals Risk factors for neurological dysfunctions after surgical repair of acute aortic dissection type A

2020 ◽  
Vol 17 (2) ◽  
pp. 70-75
Author(s):  
Djordje Zdravkovic ◽  
Ivan Nesic ◽  
Marko Kaitovic ◽  
Igor Zivkovic ◽  
Petar Vukovic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Surgical Repair ◽  
Type A ◽  
Aortic Dissection Type A

scholarly journals Intraoperative blood transfusion volume is an independent risk factor for postoperative acute kidney injury in type A acute aortic dissection

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yanli Liu ◽  
Yuqiang Shang ◽  
Ding Long ◽  
Li Yu
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Blood Transfusion ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Kidney Injury ◽  
Type A ◽  
Dependent Manner ◽  
Transfusion Volume ◽  
Postoperative Aki

Abstract Background Type A acute aortic dissection is a life-threatening disease associated with adverse clinical outcomes. Acute kidney injury (AKI) is common after surgery. However, the relationship between intraoperative blood transfusion and postoperative AKI remains unclear. Methods The records of 130 patients who underwent type A acute aortic dissection surgery from January 2015 to December 2018 were retrospectively analyzed. According to the Kidney Disease Improving Global Outcomes criteria, postoperative AKI was defined based on serum creatinine concentration. Multivariable logistic regression analysis was applied to estimate the independent association between intraoperative blood transfusion volume and the risk of postoperative AKI. Results Postoperative AKI was observed in 82 patients (63.08%). The in-hospital mortality was 16.15% (n = 21). Multivariate logistic regression showed that the amount of intraoperative blood transfusion was independently associated with the risk of postoperative AKI in a dose-dependent manner. Every 200 ml increment of blood transfusion volume was associated with a 31% increase in AKI risk (odds ratio 1.31 and 95% confidence interval 1.01–1.71). Conclusions Intraoperative transfusion volume may increase the incidence of postoperative AKI. The mechanism and influence of transfusion thresholds on AKI need to be explored in the future.

scholarly journals Acute kidney injury in patients operated on for type A acute aortic dissection: incidence, risk factors and short-term outcomes

2020 ◽  
Vol 31 (5) ◽  
pp. 697-703 ◽  
Author(s):  
Zhigang Wang ◽  
Min Ge ◽  
Tao Chen ◽  
Cheng Chen ◽  
Qiuyan Zong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Aortic Dissection ◽  
Cystatin C ◽  
Acute Aortic Dissection ◽  
Kidney Injury ◽  
Type A ◽  
Short Term ◽  
Postoperative Ventilation

Abstract OBJECTIVES Acute kidney injury (AKI) is a relatively common complication after an operation for type A acute aortic dissection and is indicative of a poor prognosis. We examined the risk factors for and the outcomes of developing AKI in patients being operated on for thoracic aortic diseases. METHODS We retrospectively analysed 712 patients with acute type A dissection who had deep hypothermic circulatory operations from January 2014 to December 2018, emphasizing those who developed AKI. Logistic regression models were used to identify predisposing factors for the postoperative development of AKI. RESULTS Among all enrolled patients, 359 (50.4%) had AKI; of these, 133 were diagnosed as stage 1 (18.7%), 126 were stage 2 (17.7%) and 100 were stage 3 (14.0%). Postoperative haemodialysis was required in 111 patients (15.9%). The development of AKI after aortic surgery contributed to the higher mortality rate within 30 days after surgery (P &lt; 0.001), longer stay in the intensive care unit (P = 0.01) and longer hospital stay (P &lt; 0.001). Binary logistic regression analysis showed that preoperative cystatin C levels [odds ratio (OR) 2.615, 95% confidence interval (CI) 1.139–6.002; P = 0.023] and postoperative ventilation time (OR 1.019, 95% CI 1.005–1.034; P = 0.009) were independent risk factors for developing AKI. Multiple ordinal logistic regression analyses showed that the preoperative cystatin C level (OR 2.921, 95% CI 1.542–5.540; P = 0.001) was an independent risk factor associated with the severity of AKI. CONCLUSIONS Our data suggested that the development of AKI after surgery for type A acute aortic dissection was common and associated with an increased short-term mortality rate. The preoperative cystatin C level was identified as an indicator for the occurrence and severity of AKI postoperatively. Furthermore, we discovered that longer postoperative ventilation time was also associated with the development of AKI.

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