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Park SJ, Park SY, Kang SY, Kim JH, Heo JY, Yoo JY. The effect of ulinastatin on acute kidney injury in patients undergoing off-pump cardiac bypass surgery. J Cardiothorac Surg 2024; 19:96. [PMID: 38360763 PMCID: PMC10870510 DOI: 10.1186/s13019-024-02562-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Ulinastatin, an anti-inflammatory and antioxidant trypsin inhibitor, has shown potential in mitigating acute kidney injury (AKI) and reducing serum creatinine levels after various surgeries. This retrospective study aimed to evaluate the effects of ulinastatin on AKI in patients undergoing off-pump coronary artery bypass (OPCAB) surgery. METHODS We hypothesized that the administration of ulinastatin could prevent AKI in OPCAB. Electrical medical records were reviewed to identify OPCAB patients between January 2015 and June 2020. The utilization of ulinastatin was randomly determined and applied during this period. Acute kidney injury was defined according to the KDIGO guideline, and its incidence was compared between the ulinastatin administration group and the control group. To investigate the effect of ulinastatin on renal function, multivariate logistic regression analysis was used to calculate propensity scores for each group. RESULTS A total 454 OPCAB were performed, and after following inclusion and exclusion process, 100 patients were identified in the ulinastatin group and 303 patients in the control group. Using 1:2 propensity score matching, we analyzed 100 and 200 patients in the ulinastatin and control groups. The incidence of AKI was similar between the groups (2.5% for the control group, 2.0% for the ulinastatin group, p > 0.999). However, the serum creatinine value on the first post-operative day were significantly lower in the ulinastatin group compared to the control group (0.774 ± 0.179 mg/dL vs 0.823 ± 0.216 mg/dL, P = 0.040), while no significant differences were observed for the other time points (P > 0.05). The length of ICU stay day was significantly shorter in the ulinastatin group (2.91 ± 2.81 day vs 5.22 ± 7.45 day, respectively, P < 0.001). CONCLUSIONS Ulinastatin did not have a significant effect on the incidence of AKI; it demonstrated the ability to reduce post-operative serum creatine levels at first post-operative day and shorten the length of ICU stay.
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Affiliation(s)
- Soo Jung Park
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 Worldcup-Ro, Yeongtong-Gu, Suwon, Korea
| | - Sung Yong Park
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 Worldcup-Ro, Yeongtong-Gu, Suwon, Korea
| | - Se Yoon Kang
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 Worldcup-Ro, Yeongtong-Gu, Suwon, Korea
| | - Ji Ho Kim
- Department of Medical Sciences, Ajou University School of Medicine, Suwon, Korea
| | - Ji Yeong Heo
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 Worldcup-Ro, Yeongtong-Gu, Suwon, Korea
| | - Ji Young Yoo
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 Worldcup-Ro, Yeongtong-Gu, Suwon, Korea.
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Pampori A, Shekhar S, Kapadia SR. Implications of Renal Disease in Patients Undergoing Structural Interventions. Interv Cardiol Clin 2023; 12:539-554. [PMID: 37673498 DOI: 10.1016/j.iccl.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Percutaneous structural interventions have a major impact on the morbidity, mortality, and quality of life of patients by providing a lower-risk alternative to cardiac surgery. However, renal disease has a significant impact on outcomes of these interventions. This review explores the incidence, outcomes, pathophysiology, and preventative measures of acute kidney injury and chronic kidney disease on transcatheter aortic valve replacement, transcatheter mitral valve repair, and percutaneous balloon mitral valvuloplasty. Given the expanding indications for percutaneous structural interventions, further research is needed to identify ideal patients with chronic kidney disease or end-stage renal disease who would benefit from intervention.
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Affiliation(s)
- Adam Pampori
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA.
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Khademi S, Heirany F, Jouybar R, Dehghanpisheh L, Ghazinoor M, Mehr LS. Effect of albumin usage during cardiopulmonary bypass on postoperative acute kidney injury in cardiac surgery patients: A historical cohort study. Ann Card Anaesth 2023; 26:288-294. [PMID: 37470527 PMCID: PMC10451135 DOI: 10.4103/aca.aca_84_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/27/2022] [Accepted: 09/26/2022] [Indexed: 07/21/2023] Open
Abstract
Introduction Acute kidney injury (AKI) after cardiac surgery is a common and serious postoperative complication and is associated with an increased risk of mortality, morbidity, length of hospital stay, and costs. We evaluated the effect of albumin usage on postoperative AKI in patients who underwent on-pump Coronary Artery Bypass Graft Surgery (CABG). Methods This non-randomized cohort study was conducted on data from adult patients who underwent elective CABG, from March of 2015 to March of 2019. We assessed two groups of patients including the albumin (who received 50cc albumin 20% in priming solution) and the non-albumin groups. We recorded demographic data, medical history, and preoperative laboratory data. We compared postoperative changes in serum creatinine (Cr), blood urea nitrogen (BUN), and Glomerular Filtration Rate (GFR) up to 72 hours after surgery with preoperative ones. Also, the stage of kidney dysfunction was assessed according to the AKIN classification. The statistical analysis of the data was processed by SPSS 24 program. Results Overall, we reviewed 506 patients chart [260 (51.4%) in albumin and 246 (48.6%) in non-albumin group]. In both groups, serum Cr, BUN, and GFR increased in 72 hours postoperatively compared with preoperative levels. This increase was greater in the non-albumin group than in the albumin group. However, the difference was not statistically significant between the two groups (p > 0.05). None of the patients developed renal failure or required dialysis. Conclusion We concluded that the use of albumin in prime solution did not have a statistically significant effect on postoperative renal dysfunction after CABG.
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Affiliation(s)
- Saeed Khademi
- Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Friba Heirany
- Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Jouybar
- Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Laleh Dehghanpisheh
- Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohmmad Ghazinoor
- Department of Surgery, Section of Cardiac Surgery, Shiraz University of Medical Sciences, Iran
| | - Leila Shojaei Mehr
- Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Kant S, Banerjee D, Sabe SA, Sellke F, Feng J. Microvascular dysfunction following cardiopulmonary bypass plays a central role in postoperative organ dysfunction. Front Med (Lausanne) 2023; 10:1110532. [PMID: 36865056 PMCID: PMC9971232 DOI: 10.3389/fmed.2023.1110532] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
Despite significant advances in surgical technique and strategies for tissue/organ protection, cardiac surgery involving cardiopulmonary bypass is a profound stressor on the human body and is associated with numerous intraoperative and postoperative collateral effects across different tissues and organ systems. Of note, cardiopulmonary bypass has been shown to induce significant alterations in microvascular reactivity. This involves altered myogenic tone, altered microvascular responsiveness to many endogenous vasoactive agonists, and generalized endothelial dysfunction across multiple vascular beds. This review begins with a survey of in vitro studies that examine the cellular mechanisms of microvascular dysfunction following cardiac surgery involving cardiopulmonary bypass, with a focus on endothelial activation, weakened barrier integrity, altered cell surface receptor expression, and changes in the balance between vasoconstrictive and vasodilatory mediators. Microvascular dysfunction in turn influences postoperative organ dysfunction in complex, poorly understood ways. Hence the second part of this review will highlight in vivo studies examining the effects of cardiac surgery on critical organ systems, notably the heart, brain, renal system, and skin/peripheral tissue vasculature. Clinical implications and possible areas for intervention will be discussed throughout the review.
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Affiliation(s)
| | | | | | | | - Jun Feng
- Cardiothoracic Surgery Research Laboratory, Department of Cardiothoracic Surgery, Rhode Island Hospital, Lifespan, Providence, RI, United States
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Mo Z, Hu P, Xie Z, Wu Y, Li Z, Fu L, Chen Y, Liang X, Liang H, Dong W. The value of the ACEF II score in Chinese patients with elective and non-elective cardiac surgery. BMC Cardiovasc Disord 2022; 22:513. [PMID: 36457097 PMCID: PMC9716978 DOI: 10.1186/s12872-022-02946-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To evaluate the value of the ACEF II score in predicting postoperative hospital death and acute kidney injury requiring dialysis (AKI-D) in Chinese patients. METHODS This retrospective study included adult patients who underwent cardiopulmonary bypass open heart surgery between January 2010 and December 2015 at Guangdong Provincial People's Hospital. ACEF II was evaluated to predict in-hospital death and AKI-D using the Hosmer-Lemeshow goodness of fit test for calibration and area under the receiver operating characteristic (ROC) curve for discrimination in non-elective and elective cardiac surgery. RESULTS A total of 9748 patients were included. Among them, 1080 underwent non-elective surgery, and 8615 underwent elective surgery. Mortality was 1.8% (177/9748). In elective surgery, the area under the ROC (AUC) of the ACEF II score was 0.704 (95% CI: 0.648-0.759), similar to the ACEF score of 0.709 (95% CI: 0.654-0.763). In non-elective surgery, the AUC of the ACEF II score was 0.725 (95% CI: 0.663-0.787), higher than the ACEF score (AUC = 0.625, 95% CI: 0.553-0.697). The incidence of AKI-D was 3.5% (345/9748). The AUC of the ACEF II score was 0.718 (95% CI: 0.687-0.749), higher than the ACEF score (AUC = 0.626, 95% CI: 0.594-0.658). CONCLUSION ACEF and ACEF II have poor discrimination ability in predicting AKI-D in non-elective surgery. The ACEF II and ACEF scores have the same ability to predict in-hospital death in elective cardiac surgery, and the ACEF II score is better in non-elective surgery. The ACEF II score can be used to assess the risk of AKI-D in elective surgery in Chinese adults.
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Affiliation(s)
- Zhiming Mo
- grid.284723.80000 0000 8877 7471The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China ,grid.413405.70000 0004 1808 0686Department of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Penghua Hu
- Division of Nephrology, The Affiliated Yixing Hospital of Jiangsu University, Yixing, China
| | - Zhiyong Xie
- grid.413405.70000 0004 1808 0686Department of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yanhua Wu
- grid.413405.70000 0004 1808 0686Department of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhilian Li
- grid.413405.70000 0004 1808 0686Department of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lei Fu
- grid.413405.70000 0004 1808 0686Department of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuanhan Chen
- grid.284723.80000 0000 8877 7471The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China ,grid.413405.70000 0004 1808 0686Department of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xinling Liang
- grid.284723.80000 0000 8877 7471The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China ,grid.413405.70000 0004 1808 0686Department of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huaban Liang
- grid.413405.70000 0004 1808 0686Department of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei Dong
- grid.413405.70000 0004 1808 0686Department of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Kolar T, Lakič N, Kotnik A, Štubljar D, Fras Z, Bunc M. Similar clinical outcomes with transcatheter aortic valve implantation and surgical aortic valve replacement in octogenarians with aortic stenosis. Front Cardiovasc Med 2022; 9:947197. [DOI: 10.3389/fcvm.2022.947197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTranscatheter aortic valve implantation (TAVI) is the preferred treatment option for severe aortic stenosis in the elderly and in patients with comorbidities. We sought to compare outcomes after TAVI and surgical aortic valve replacement (SAVR) in octogenarians.MethodsIn this retrospective cohort study conducted at our tertiary center, clinical data were gathered before and after TAVI and SAVR procedures performed from January 2013 to May 2019; follow-up completed in March 2021. The primary outcome was 1-year mortality. Patients were stratified according to Society of Thoracic Surgeons (STS) score and procedure type. Propensity score-based matching was also performed.ResultsOf 542 patients who matched the inclusion criteria, 273 underwent TAVI and 269 SAVR. TAVI patients were older (85.8 ± 3.0 vs. 82.2 ± 2.2 years; P < 0.001) and had a higher mean STS score (5.0 ± 4.0 vs. 2.8 ± 1.3; P < 0.001) and EuroSCORE II (5.3 ± 4.1 vs. 2.8 ± 6.0; P < 0.001). Rates of postoperative permanent pacemaker insertion (15.0% vs. 9.3%; P = 0.040) and paravalvular leak (9.9% vs. 0.8%; P < 0.001) were higher and acute kidney injury lower (8.8% vs. 32.7%; P < 0.001) after TAVI, with no difference between treatment groups for major bleeding (11.0% vs. 6.7%; P = 0.130) or 30-day mortality (5.5% vs. 3.7%; P = 0.315). A statistically significant difference was found between TAVI and SAVR in low- and intermediate-risk groups when it came to occurrence of paravalvular leak, acute kidney injury, and new onset AF (all P < 0.001).ConclusionThis analysis of an octogenarian “real-life” population undergoing TAVI or SAVR (with a biological valve) showed similar outcomes regarding clinical endpoints in low- and medium-risk (STS score) groups.
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Ejmalian A, Aghaei A, Nabavi S, Abedzadeh Darabad M, Tajbakhsh A, Abin AA, Ebrahimi Moghaddam M, Dabbagh A, Jahangirifard A, Memary E, Sayyadi S. Prediction of Acute Kidney Injury After Cardiac Surgery Using Interpretable Machine Learning. Anesth Pain Med 2022; 12:e127140. [PMID: 36937087 PMCID: PMC10016126 DOI: 10.5812/aapm-127140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/16/2022] [Accepted: 09/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background Acute kidney injury (AKI) is a complication that occurs for various reasons after surgery, especially cardiac surgery. This complication can lead to a prolonged treatment process, increased costs, and sometimes death. Prediction of postoperative AKI can help anesthesiologists to implement preventive and early treatment strategies to reduce the risk of AKI. Objectives This study tries to predict postoperative AKI using interpretable machine learning models. Methods For this study, the information of 1435 patients was collected from multiple centers. The gathered data are in six categories: demographic characteristics and type of surgery, past medical history (PMH), drug history (DH), laboratory information, anesthesia and surgery information, and postoperative variables. Machine learning methods, including support vector machine (SVM), multilayer perceptron (MLP), decision tree (DT), random forest (RF), logistic regression, XGBoost, and AdaBoost, were used to predict postoperative AKI. Local interpretable model-agnostic explanations (LIME) and the Shapley methods were then leveraged to check the interpretability of models. Results Comparing the area under the curves (AUCs) obtained for different machine learning models show that the RF and XGBoost methods with values of 0.81 and 0.80 best predict postoperative AKI. The interpretations obtained for the machine learning models show that creatinine (Cr), cardiopulmonary bypass time (CPB time), blood sugar (BS), and albumin (Alb) have the most significant impact on predictions. Conclusions The treatment team can be informed about the possibility of postoperative AKI before cardiac surgery using machine learning models such as RF and XGBoost and adjust the treatment procedure accordingly. Interpretability of predictions for each patient ensures the validity of obtained predictions.
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Affiliation(s)
- Azar Ejmalian
- Deptartment of Anesthesiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Atefe Aghaei
- Faculty of Computer Science and Engineering, Shahid Beheshti University, Tehran, Iran
| | - Shahabedin Nabavi
- Faculty of Computer Science and Engineering, Shahid Beheshti University, Tehran, Iran
| | | | - Ardeshir Tajbakhsh
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Ali Abin
- Faculty of Computer Science and Engineering, Shahid Beheshti University, Tehran, Iran
| | | | - Ali Dabbagh
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Jahangirifard
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Memary
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Sayyadi
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Kurniawaty J, Setianto BY, Supomo, Widyastuti Y, Boom CE. The Effect of Low Preoperative Ejection Fraction on Mortality After Cardiac Surgery in Indonesia. Vasc Health Risk Manag 2022; 18:131-137. [PMID: 35356550 PMCID: PMC8959716 DOI: 10.2147/vhrm.s350671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/10/2022] [Indexed: 12/02/2022] Open
Abstract
Background Among cardiac surgery patients, low preoperative left ventricular ejection fraction (LVEF) is common and has been associated with poor outcomes. The objective of this study was to assess the association between LVEF and postoperative mortality in patients undergoing open-heart surgery in several hospitals in Indonesia. Methods We conducted a multicenter study with the retrospective design using data from patients undergoing open-heart surgery in 4 institutions in Indonesia. Data regarding LVEF and other potential risk factors were extracted from medical records and compiled in one datasheet. Statistical analyses were performed to assess if low LVEF was associated with postoperative mortality and identify other potential risk factors. Results A total of 4789 patients underwent cardiac surgery in participating centers during the study period. Of these, 189 subjects (3.9%) had poor preoperative LVEF. Poor LVEF was associated with postoperative mortality (adjusted OR 2.761, 95% CI 1.763–4.323, p < 0.001). Based on types of surgery, LVEF had a significant association with mortality only in CABG patients, while there was no such association in valve surgery and inconclusive in congenital surgery patients. Other significant independent predictors of in-hospital mortality included age more than 65 years old, non-elective surgery, the complexity of procedures, history of cardiac surgery, organ failure, CARE score ≥ 3, NYHA class ≥ III, and poor right ventricular function. Conclusion Patients with low preoperative LVEF undergoing open-heart surgery had a higher risk of postoperative mortality. Cardiac surgery can be performed with acceptable mortality rates. Accurate selection of patients, risk/benefit evaluation, and planning of surgical and anesthesiological management are mandatory to improve outcomes.
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Affiliation(s)
- Juni Kurniawaty
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Budi Yuli Setianto
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Supomo
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yunita Widyastuti
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Cindy E Boom
- Harapan Kita National Heart Center, Jakarta, Indonesia
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Lee Y, Kim SH, Hwang HY, Sohn SH, Choi JW, Kim KH. Perfusion parameters during cardiopulmonary bypass as a predictor of acute kidney injury after aortic valve replacement. Acute Crit Care 2021; 36:242-248. [PMID: 34380189 PMCID: PMC8435448 DOI: 10.4266/acc.2021.00094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022] Open
Abstract
Background Acute kidney injury (AKI) is a major complication after cardiac surgery and significantly affects postoperative mortality and morbidity. This study was conducted to evaluate the association between target pump flow to achieve adequate oxygen delivery (DO2) and postoperative renal function after aortic valve replacement. Methods From January 2017 to May 2020, 281 patients (male:female, 160:121; mean age, 68±11 years) who underwent aortic valve replacement were retrospectively reviewed. Target pump flow was calculated based on DO2 level of 280 mL/min/m2. The primary endpoint was postoperative renal dysfunction, defined as the ratio of postoperative peak creatinine level to preoperative value. The ratio of the lowest actual pump flow to the ideal target pump flow, other hemodynamic variables related with cardiopulmonary bypass, intraoperative transfusion, and preoperative characteristics were analyzed to identify factors associated with the primary endpoint using a multivariable linear regression model. Results Preoperative and peak postoperative creatinine levels were 0.94±0.33 mg/dl and 1.15±0.56 mg/dl, respectively (ratio, 1.22±0.33). The ideal target pump flow was 4.70±0.59 L/min, whereas the lowest actual pump flow was 3.77±0.47 L/min (ratio, 0.81±0.13). The multivariable model showed that the ratio of the lowest pump flow to target pump flow (β±standard error, –0.405±0.162, P=0.013), as well as sex, stroke history, emergency operation, and transfusion of red blood cells were associated with the primary endpoint. Conclusions Low actual nadir pump flow compared to the ideal target pump flow based on DO2 is associated with the risk of AKI after aortic valve replacement.
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Affiliation(s)
- Yeiwon Lee
- Department of Critical Care, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sue Hyun Kim
- Department of Critical Care, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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BOLAT A, SURER S, GÜLBAHAR Ö, BOLAT E, GÜLTEKİN Y, KUTSAL A. The effect of phosphorolcoline-coated cardiopulmonary by-pass circuits on morbidity and mortality in patients with congenital open cardiac surgery. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.854196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Bianco V, Kilic A, Mulukutla S, Gleason TG, Kliner D, Allen CC, Habertheuer A, Aranda-Michel E, Humar R, Navid F, Wang Y, Sultan I. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with reduced ejection fraction. J Thorac Cardiovasc Surg 2021; 161:1022-1031.e5. [DOI: 10.1016/j.jtcvs.2020.06.159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 06/18/2020] [Accepted: 06/27/2020] [Indexed: 10/23/2022]
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Maile MD, Mathis MR, Habib RH, Schwann TA, Engoren MC. Association of Both High and Low Left Ventricular Ejection Fraction With Increased Risk After Coronary Artery Bypass Grafting. Heart Lung Circ 2021; 30:1091-1099. [PMID: 33516659 DOI: 10.1016/j.hlc.2020.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/20/2020] [Accepted: 11/05/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND While reduced left ventricular ejection fraction (LVEF) is a known risk factor for complications after coronary artery bypass grafting (CABG), the relevance of higher LVEF values has not been established. Currently, most risk stratification tools consider LVEF values above a certain point as normal. However, since this does not account for insufficient ventricular filling or increased adrenergic tone, higher values may have clinical significance. To improve our understanding of this situation, we investigated the relationship of preoperative LVEF values with short- and long-term outcomes after CABG using a strategy that allowed for the identification of nonlinear relationships. We hypothesised that both higher and lower values are independently associated with increased postoperative complications and death in this population. METHODS We performed a single-centre retrospective cohort study of patients undergoing isolated CABG surgery. All patients had a preoperative measurement of their LVEF. Surgery involving mitral valve repair was excluded in order to eliminate the impact of mitral regurgitation. The primary outcome was long-term mortality; secondary outcomes included atrial fibrillation, operative mortality, and a composite outcome including any postoperative adverse event. Fractional polynomial equations were used to model the relationship between LVEF and outcomes so we could account for nonlinear relationships if present. Adjustments for confounders were made using multivariable logistic regression and Cox models. RESULTS A total of 7,932 subjects were included in the study. After adjusting for patient and surgical characteristics, LVEF remained associated with the primary outcome as well as the composite outcome of any postoperative adverse event. Both these relationships were best described by a J-shaped curve given that higher LVEF values were associated with increased risk, albeit not as high has lower values. Regarding long-term mortality, individuals with a preoperative LVEF of 60% demonstrated the longest survival. A statistically significant relationship was not found between LVEF and operative mortality or atrial fibrillation after adjustment for confounders. CONCLUSIONS Higher preoperative LVEF values may be associated with increased risk for patients undergoing CABG surgery. Future studies are needed to better characterise this phenotype.
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Affiliation(s)
- Michael D Maile
- Division of Critical Care Medicine, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA. https://twitter.com/MikeMaile_MD
| | - Michael R Mathis
- Division of Adult Cardiothoracic Anesthesiology, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Robert H Habib
- The Society of Thoracic Surgeons Research Center, Chicago, IL, USA
| | - Thomas A Schwann
- Division of Cardiac Surgery, Department of Surgery, University of Massachusetts, University of Massachusetts-Baystate, Springfield, MA, USA
| | - Milo C Engoren
- Division of Critical Care Medicine, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
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Iacovelli F, Pignatelli A, Cafaro A, Stabile E, Salemme L, Cioppa A, Pucciarelli A, Spione F, Loizzi F, De Cillis E, Pestrichella V, Bortone AS, Tesorio T, Contegiacomo G. Impact of contrast medium osmolality on the risk of acute kidney injury after transcatheter aortic valve implantation: insights from the Magna Graecia TAVI registry. Int J Cardiol 2020; 329:56-62. [PMID: 33359334 DOI: 10.1016/j.ijcard.2020.12.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/25/2020] [Accepted: 12/11/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) is frequent and associated with adverse outcomes and mortality; to date, in such setting of patients there is no consistent evidence that either low-osmolar contrast media (LOCM) or iso-osmolar contrast medium (IOCM) are superior to the other in terms of renal safety. METHODS 697 consecutive patients not in hemodialysis treatment who underwent TAVI (327 males, mean age 81.01 ± 5.75 years, mean european system for cardiac operative risk evaluation II 6.17 ± 0.23%) were enrolled. According to osmolality of the different iodinated CM, the population was divided in 2 groups: IOCM (n = 370) and LOCM group (n = 327). Preoperatively, 40.54% of patients in IOCM vs 39.14% in LOCM group (p = 0.765) suffered from chronic kidney disease (CKD). RESULTS The incidence of AKI was significantly lower with IOCM (9.73%) than with LOCM (15.90%; p = 0.02), and such significant difference (p < 0.001) in postprocedural change of renal function parameters persisted at discharge too. The incidence of AKI was also significantly lower with IOCM in younger patients, without diabetes, anemia, coronary artery disease history, CKD, chronic or persistent atrial fibrillation, left ventricular ejection fraction ≤35%, and in patients with low operative mortality risk scores, receiving lower amounts of dye (p < 0.05 for all). Importantly, multivariate analysis identified LOCM administration as an independent risk factor for both AKI (p = 0.006) and 1-year mortality (p = 0.001). CONCLUSIONS The use of IOCM have a favorable impact on renal function with respect to LOCM, but it should be considered especially for TAVI patients at lower AKI risk.
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Affiliation(s)
- Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy.
| | - Antonio Pignatelli
- Interventional Cardiology Service, "Anthea" Clinic, GVM Care & Research, Bari, Italy
| | | | - Eugenio Stabile
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Luigi Salemme
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Angelo Cioppa
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Armando Pucciarelli
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Francesco Spione
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | - Francesco Loizzi
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | - Emanuela De Cillis
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | | | - Alessandro Santo Bortone
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | - Tullio Tesorio
- Interventional Cardiology Service, "Montevergine" Clinic, Mercogliano, Italy
| | - Gaetano Contegiacomo
- Interventional Cardiology Service, "Anthea" Clinic, GVM Care & Research, Bari, Italy
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Zhao L, Cao X, Li L, Wang Q, Zhou S, Xu N, Jiang S, Chen L, Schmidt MO, Wei Q, Zhao J, Labes R, Patzak A, Wilcox CS, Fu X, Wellstein A, Lai EY. Acute Kidney Injury Sensitizes the Brain Vasculature to Ang II (Angiotensin II) Constriction via FGFBP1 (Fibroblast Growth Factor Binding Protein 1). Hypertension 2020; 76:1924-1934. [PMID: 33040621 PMCID: PMC9112323 DOI: 10.1161/hypertensionaha.120.15582] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/14/2020] [Indexed: 12/26/2022]
Abstract
Acute kidney injury (AKI) causes multiple organ dysfunction. Here, we identify a possible mechanism that can drive brain vessel injury after AKI. We induced 30-minute bilateral renal ischemia-reperfusion injury in C57Bl/6 mice and isolated brain microvessels and macrovessels 24 hours or 1 week later to test their responses to vasoconstrictors and found that after AKI brain vessels were sensitized to Ang II (angiotensin II). Upregulation of FGF2 (fibroblast growth factor 2) and FGFBP1 (FGF binding protein 1) expression in both serum and kidney tissue after AKI suggested a potential contribution to the vascular sensitization. Administration of FGF2 and FGFBP1 proteins to isolated healthy brain vessels mimicked the sensitization to Ang II after AKI. Brain vessels in Fgfbp1-/- AKI mice failed to induce Ang II sensitization. Complementary to this, systemic treatment with the clinically used FGF receptor kinase inhibitor BGJ398 (Infigratinib) reversed the AKI-induced brain vascular sensitization to Ang II. All these findings lead to the conclusion that FGFBP1 is especially necessary for AKI-mediated brain vascular sensitization to Ang II and inhibitors of FGFR pathway may be beneficial in preventing AKI-induced brain vessel injury.
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Affiliation(s)
- Liang Zhao
- Department of Physiology, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou 511436, China
- Department of Physiology, School of Basic Medical Sciences, Zhejiang University School of Medicine, Hangzhou 310003, China
- Institute of Vegetative Physiology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Xiaoyun Cao
- Department of Physiology, School of Basic Medical Sciences, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Lingli Li
- Division of Nephrology and Hypertension, Georgetown University, Washington, DC 20007, USA
| | - Qin Wang
- Department of Physiology, School of Basic Medical Sciences, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Suhan Zhou
- Department of Physiology, School of Basic Medical Sciences, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Nan Xu
- Department of Physiology, School of Basic Medical Sciences, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Shan Jiang
- Department of Physiology, School of Basic Medical Sciences, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Limeng Chen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
| | - Marcel O. Schmidt
- Lombardi Cancer Center, Georgetown University, Washington, DC 20007, USA
| | - Qichun Wei
- Department of Radiation Oncology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Jingwei Zhao
- Department of Anatomy, Histology and Embryology, Institute of Neuroscience, School of Basic Medical Sciences, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Robert Labes
- Institute of Vegetative Physiology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Andreas Patzak
- Institute of Vegetative Physiology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Christopher S. Wilcox
- Division of Nephrology and Hypertension, Georgetown University, Washington, DC 20007, USA
| | - Xiaodong Fu
- Department of Gynecology and Obstetrics, the Sixth Affiliated Hospital, Guangzhou Medical University, Guangzhou 511518, China
| | - Anton Wellstein
- Lombardi Cancer Center, Georgetown University, Washington, DC 20007, USA
| | - En Yin Lai
- Department of Physiology, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou 511436, China
- Department of Physiology, School of Basic Medical Sciences, Zhejiang University School of Medicine, Hangzhou 310003, China
- Institute of Vegetative Physiology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
- Division of Nephrology and Hypertension, Georgetown University, Washington, DC 20007, USA
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15
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Intraoperative blood transfusion volume is an independent risk factor for postoperative acute kidney injury in type A acute aortic dissection. BMC Cardiovasc Disord 2020; 20:446. [PMID: 33054744 PMCID: PMC7557070 DOI: 10.1186/s12872-020-01727-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 10/06/2020] [Indexed: 12/14/2022] Open
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.
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Ngu JMC, Jabagi H, Chung AM, Boodhwani M, Ruel M, Bourke M, Sun LY. Defining an Intraoperative Hypotension Threshold in Association with De Novo Renal Replacement Therapy after Cardiac Surgery. Anesthesiology 2020; 132:1447-1457. [PMID: 32205546 DOI: 10.1097/aln.0000000000003254] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is a frequent and deadly complication after cardiac surgery. In the absence of effective therapies, a focus on risk factor identification and modification has been the mainstay of management. The authors sought to determine the impact of intraoperative hypotension on de novo postoperative renal replacement therapy in patients undergoing cardiac surgery, hypothesizing that prolonged periods of hypotension during and after cardiopulmonary bypass (CPB) were associated with an increased risk of renal replacement therapy. METHODS Included in this single-center retrospective cohort study were adult patients who underwent cardiac surgery requiring CPB between November 2009 and April 2015. Excluded were patients who were dialysis dependent, underwent thoracic aorta or off-pump procedures, or died before receiving renal replacement therapy. Degrees of hypotension were defined by mean arterial pressure (MAP) as less than 55, 55 to 64, and 65 to 74 mmHg before, during, and after CPB. The primary outcome was de novo renal replacement therapy. RESULTS Of 6,523 patient records, 336 (5.2%) required new postoperative renal replacement therapy. Each 10-min epoch of MAP less than 55 mmHg post-CPB was associated with an adjusted odds ratio of 1.13 (95% CI, 1.05 to 1.23; P = 0.002), and each 10-min epoch of MAP between 55 and 64 mmHg post-CPB was associated with an adjusted odds ratio of 1.12 (95% CI, 1.06 to 1.18; P = 0.0001) for renal replacement therapy. The authors did not observe an association between hypotension before and during CPB with renal replacement therapy. CONCLUSIONS MAP less than 65 mmHg for 10 min or more post-CPB is associated with an increased risk of de novo postoperative renal replacement therapy. The association between intraoperative hypotension and AKI was weaker in comparison to factors such as renal insufficiency, heart failure, obesity, anemia, complex or emergent surgery, and new-onset postoperative atrial fibrillation. Nonetheless, post-CPB hypotension is a potentially easier modifiable risk factor that warrants further investigation.
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Affiliation(s)
- Janet M C Ngu
- From the Division of Cardiac Surgery (J.M.C.N., H.J., M. Boodhwani, M.R.) the Division of Cardiac Anesthesiology (A.M.C., M. Bourke, L.Y.S.) Cardiocore Big Data Research Unit (L.Y.S.), University of Ottawa Heart Institute, Ottawa, Canada the School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada (L.Y.S.) the Cardiovascular Research Program, Institute for Clinical Evaluative Sciences, Toronto, Canada (L.Y.S.)
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Ma X, Li J, Yun Y, Zhao D, Chen S, Ma H, Wang Z, Zhang H, Zou C, Cui Y. Risk factors analysis of acute kidney injury following open thoracic aortic surgery in the patients with or without acute aortic syndrome: a retrospective study. J Cardiothorac Surg 2020; 15:213. [PMID: 32767994 PMCID: PMC7412815 DOI: 10.1186/s13019-020-01257-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background The acute kidney injury (AKI) remains a frequent complication following open thoracic aortic surgery (OTAS) and worsens the postoperative prognosis. It remains unclear that whether the predictors of AKI following OTAS are different in the patients with or without acute aortic syndrome (AAS). Methods Preoperative and intraoperative variables were compared between the patients with or without AKI, and were further analyzed for identifying the potential predictors of postoperative AKI. Subgroup analysis was conducted in the patients with or without AAS, respectively. Results AKI after OTAS occurred in 57.6% of the overall cohort, 70.1% of the patients with AAS and 46.7% of the patients without AAS. In the multivariate analysis, history of hypertension (OR 1.011, 95% CI: [1.001–1.022], p = 0.04), preoperative platelet (OR 0.995, 95% CI: [0.991–0.999], p = 0.006) and operation time (OR 1.572, 95% CI: [1.355–1.823], p < 0.001) were identified as independent predictors of postoperative AKI for the overall cohort; CPB time (OR 1.020, 95% CI: [1.009–1.031], p < 0.001) and preoperative LMR (OR 0.823, 95% CI: [0.701–0.966], p = 0.02) as independent predictors for the patients with AAS; age (OR 1.045, 95% CI: [1.015–1.076], p = 0.003), preoperative platelet (OR 0.993, 95% CI: [0.988–0.998], p = 0.04) and operation time (OR 1.496, 95% CI: [1.166–1.918], p = 0.002) as independent predictors for the patients without AAS. Conclusions The patients with AAS carry a higher risk for postoperative AKI compared with those without AAS. The predictive factors for postoperative AKI after OTAS are different for AAS- and non-AAS subgroups and operation time, CPB time and preoperative platelet are modifiable predictors of AKI.
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Affiliation(s)
- Xiaochun Ma
- Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324 Jingwu Road, Jinan, 250021, Shandong, China. .,Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong University, No.324 Jingwu Road, Jinan, 250021, Shandong, China.
| | - Jinzhang Li
- College of Basic Medicine, Capital Medical University, Beijing, China
| | - Yan Yun
- Department of Radiology, Qilu Hospital of Shandong University, No.107 West Wenhua Road, Jinan, 250012, Shandong, China
| | - Diming Zhao
- Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324 Jingwu Road, Jinan, 250021, Shandong, China.,Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong University, No.324 Jingwu Road, Jinan, 250021, Shandong, China
| | - Shanghao Chen
- Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324 Jingwu Road, Jinan, 250021, Shandong, China.,Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong University, No.324 Jingwu Road, Jinan, 250021, Shandong, China
| | - Huibo Ma
- Qingdao University Medical College, Qingdao University, 308 Ningxia Road, Qingdao, 266071, Shandong, China
| | - Zhengjun Wang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324 Jingwu Road, Jinan, 250021, Shandong, China.,Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong University, No.324 Jingwu Road, Jinan, 250021, Shandong, China
| | - Haizhou Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324 Jingwu Road, Jinan, 250021, Shandong, China.,Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong University, No.324 Jingwu Road, Jinan, 250021, Shandong, China
| | - Chengwei Zou
- Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324 Jingwu Road, Jinan, 250021, Shandong, China.,Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong University, No.324 Jingwu Road, Jinan, 250021, Shandong, China
| | - Yuqi Cui
- Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324 Jingwu Road, Jinan, 250021, Shandong, China. .,Center for Precision Medicine and Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO, 65212, USA.
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18
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Ibrahim KS, Kheirallah KA, Mayyas FA, Alwaqfi NA. Predictors of Acute Kidney Injury Following Surgical Valve Replacement. Thorac Cardiovasc Surg 2020; 69:396-404. [PMID: 32711404 DOI: 10.1055/s-0040-1710318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Acute kidney injury is a serious complication after surgical valve replacement and holds increased mortality rates. OBJECTIVES To study predictors of acute kidney injury after surgical valve replacement. MATERIALS AND METHODS Patients who underwent valve surgery procedures at our center were included. Procedures included aortic valve replacement (AVR), mitral valve replacement (MVR), AVR with coronary artery bypass grafting (CABG), MVR with CABG, or AVR and MVR with/without CABG. RESULTS A total of 346 patients were included. The mean age was 51.56 (16.1). Males (n = 178) comprised 51%.At the univariate level analysis, predictors of acute kidney injury were found including age, ejection fraction, hypertension, history of CAD, emergency surgery, recent myocardial infarction, diabetes, atrial fibrillation, history of heart failure, mitral regurgitation (MR), pump time >120 minutes, aortic cross clamp >90 minutes, perioperative blood transfusion, re-exploration for bleeding, use of mechanical and biologic valve in aortic position, use of biologic valve in mitral position, prolonged inotropic support, postoperative stroke, and use of angiotensin converting enzyme inhibitors (ACEi) < a month, (all p < 0.05).By Logistic regression analysis, Age (p < 0.0001, odds ratio[AOR] = 1.076), hypertension (p = 0.039, AOR = 1.829), heart failure (p = 0.019, AOR = 2.448), MR (p = 0.0001, AOR = 3.110), use of ACEi <month (p = 0.043, AOR= 2.181), pump time >120 minutes (p = 0.022, AOR = 1.797), perioperative blood transfusion (p = 0.008, AOR = 2.532), and prolonged inotropic support (p = 0.012, AOR = 2.591) were significant and independent predictors of AKI. CONCLUSION Independent predictors of acute kidney injury following valve surgeries include age, hypertension, heart failure, MR, use of ACEi <month, perioperative blood transfusion, and prolonged pump time or inotropic support.
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Affiliation(s)
- Khalid S Ibrahim
- Division of Cardiac Surgery, Department of General Surgery and Urology, College of Medicine, Jordan University of Science and Technology, Irbid, Jordan.,Princess Muna Center for Heart Diseases and Surgery, King Abdullah University Hospital, Irbid, Jordan
| | - Khalid A Kheirallah
- Department of Public Health and Community Health, College of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Fadia A Mayyas
- Department of Clinical Pharmacy, College of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Nizar A Alwaqfi
- Division of Cardiac Surgery, Department of General Surgery and Urology, College of Medicine, Jordan University of Science and Technology, Irbid, Jordan.,Princess Muna Center for Heart Diseases and Surgery, King Abdullah University Hospital, Irbid, Jordan
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Lee CJ, Gardiner BS, Smith DW. A cardiovascular model for renal perfusion during cardiopulmonary bypass surgery. Comput Biol Med 2020; 119:103676. [PMID: 32339121 DOI: 10.1016/j.compbiomed.2020.103676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 01/05/2023]
Abstract
Acute kidney injury (AKI) is a major complication following cardiac surgery requiring cardiopulmonary bypass (CPB). It is likely that poor renal perfusion contributes to the occurrence of AKI, via renal hypoxia, so it is imperative to maintain optimal renal perfusion during CPB. We have developed a straightforward cardiovascular perfusion model with parameter values calibrated against experimental and/or clinical data from several independent studies of CPB in humans and animals. Following model development and calibration, we performed a one-at-a-time parametric study to investigate the response of renal perfusion to several variables during CPB, namely pump flow (denoted CO for 'cardiac output'), renal vascular resistance, and non-renal vascular resistance. From the parametric study, we have found that all three parameters had a similarly strong influence on renal perfusion. We simulated three potential strategies for maintaining optimum renal perfusion during CPB and tested their effectiveness. The strategies were: (1) increasing the pump flow; (2) administrating noradrenaline (vasopressor); and (3) administrating fenoldopam (renal vasodilator). Simulations have revealed that administration of fenoldopam is likely to be the most effective of the three strategies. Other findings from our simulations are that increasing pump flow is less effective when central venous pressure is elevated. Further, renal autoregulation is likely inoperative during CPB, as evidenced by an unchanging renal vascular resistance with increasing CO and blood pressure. The cardiac-renal perfusion model developed in this study can be linked with other kidney models to simulate the changes in renal oxygenation during CPB.
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Affiliation(s)
- Chang-Joon Lee
- College of Science, Health, Engineering and Education Murdoch University, 90 South St, Murdoch, WA, 6150, Australia.
| | - Bruce S Gardiner
- College of Science, Health, Engineering and Education Murdoch University, 90 South St, Murdoch, WA, 6150, Australia
| | - David W Smith
- Faculty of Engineering and Mathematical Sciences, The University of Western Australia, Perth, Australia
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Vanstraelen S, Yilmaz A. Video-assisted thoracoscopic sternal adhesiolysis before resternotomy reduces morbidity and improves patient care. J Card Surg 2020; 35:1051-1056. [PMID: 32293056 DOI: 10.1111/jocs.14534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Resternotomy still carries an important risk for an already high-risk population. Re-entry injuries may lead to massive bleeding, which can be difficult to control due to poor accessibility. The aim of the study was to assess early outcomes of video-assisted thoracoscopic adhesiolysis, as well as safety and feasibility. METHODS Forty-five patients received a video-assisted thoracoscopic adhesiolysis before resternotomy between April 1, 2016 and January 1, 2019. Records were reviewed for demographics, perioperative and early postoperative (Postop) outcomes. RESULTS The median age of the population was 73 years with a EUROSCORE II of 8.322. Only 1 (2.22%) patient experienced a major and 2 (4.44%) a minor re-entry injury. This resulted in a mean peroperative and 24-hour Postop blood loss of, respectively, 675.72 (range: 5-2862) and 444.71 mL (range: 0-2100). There was no significant difference between the use of minimally invasive and classic extracorporeal circulation (P = .276 and P = .81, respectively). Twenty-nine patients (64%) were not in need of red blood cell transfusion. A survival rate of 93.33% could be achieved. No deaths (n = 3) were related to the video-assisted thoracoscopic adhesiolysis or re-entry injuries. Kidney function remained stale postoperatively with creatinine preoperative and Postop levels of 1.56 (95%confidence interval: 1.07-2.05) and 1.43 (95%CI, 1.05-1.81) mg/dL (P = .264). Despite high-risk surgery, the median length of stay was 8 days. CONCLUSION A video-assisted thoracoscopic approach allows for a safe and effective adhesiolysis, due to increased visibility and accuracy. This approach may prevent major and minor re-entry injuries and consequently reduce perioperative morbidity and mortality of high-risk surgery.
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Affiliation(s)
| | - Alaaddin Yilmaz
- Department of Cardiothoracic Surgery, Jessa Hospital, Hasselt, Belgium
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21
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Shah B, Villablanca PA, Vemulapalli S, Manandhar P, Amoroso NS, Saric M, Staniloae C, Williams MR. Outcomes After Transcatheter Mitral Valve Repair in Patients With Renal Disease. Circ Cardiovasc Interv 2020; 12:e007552. [PMID: 30704286 DOI: 10.1161/circinterventions.118.007552] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Renal disease is associated with poor prognosis despite guideline-directed cardiovascular therapy, and outcomes by sex in this population remain uncertain. METHODS AND RESULTS Patients (n=5213) who underwent a MitraClip procedure in the National Cardiovascular Data Registry Transcatheter Valve Therapy registry were evaluated for the primary composite outcome of all-cause mortality, stroke, and new requirement for dialysis by creatinine clearance (CrCl). Centers for Medicare and Medicaid Services-linked data were available in 63% of patients (n=3300). CrCl was <60 mL/min in 77% (n=4010) and <30 mL/min in 23% (n=1183) of the cohort. Rates of primary outcome were higher with lower CrCl (>60 mL/min, 1.4%; 30-<60 mL/min, 2.7%; <30 mL/min, 5.2%; dialysis, 7.8%; P<0.001), and all low CrCl groups were independently associated with the primary outcome (30-<60 mL/min: adjusted odds ratio, 2.32; 95% CI, 1.38-3.91; <30 mL/min: adjusted odds ratio, 4.44; 95% CI, 2.63-7.49; dialysis: adjusted hazards ratio, 4.52; 95% CI, 2.08-9.82) when compared with CrCl >60 mL/min. Rates of 1-year mortality were higher with lower CrCl (>60 mL/min, 13.2%; 30-<60 mL/min, 18.8%; <30 mL/min, 29.9%; dialysis, 32.3%; P<0.001), and all low CrCl groups were independently associated with 1-year mortality (30-<60 mL/min: adjusted hazards ratio, 1.50; 95% CI, 1.13-1.99; <30 mL/min: adjusted hazards ratio, 2.38; 95% CI, 1.78-3.20; adjusted hazards ratio: dialysis, 2.44; 95% CI, 1.66-3.57) when compared with CrCl >60 mL/min. CONCLUSIONS The majority of patients who undergo MitraClip have renal disease. Preprocedural renal disease is associated with poor outcomes, particularly in stage 4 or 5 renal disease where 1-year mortality is observed in nearly one-third. Studies to determine how to further optimize outcomes in this population are warranted.
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Affiliation(s)
- Binita Shah
- Department of Medicine (Cardiology), VA New York Harbor Healthcare System (Manhattan Campus) and New York University School of Medicine (B.S.)
| | - Pedro A Villablanca
- Department of Medicine (Cardiology) (P.A.V., N.S.A., M.S., C.S.), New York University School of Medicine
| | | | | | - Nicholas S Amoroso
- Department of Medicine (Cardiology) (P.A.V., N.S.A., M.S., C.S.), New York University School of Medicine
| | - Muhamed Saric
- Department of Medicine (Cardiology) (P.A.V., N.S.A., M.S., C.S.), New York University School of Medicine
| | - Cezar Staniloae
- Department of Medicine (Cardiology) (P.A.V., N.S.A., M.S., C.S.), New York University School of Medicine
| | - Mathew R Williams
- Department of Cardiothoracic Surgery (Adult Cardiac Surgery) (M.R.W.), New York University School of Medicine
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Aksoy R, Adademir T, Yilmaz E, Cevirme D, Sengor M, Koksal C, Rabus MB. Is Hypoalbuminemia a Predictor for Acute Kidney Injury after Coronary Bypass Grafting in Diabetes Mellitus Patients? Braz J Cardiovasc Surg 2019; 34:565-571. [PMID: 31165612 PMCID: PMC6852450 DOI: 10.21470/1678-9741-2018-0291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective Acute kidney injury (AKI) is one of the most important complications after
coronary artery bypass grafting (CABG) procedure. Serum albumin, which is an
acute phase reactant, is suggested to be associated with AKI development
subsequent to various surgical procedures. In this study, we research the
relation between preoperative serum albumin levels and postoperative AKI
development in diabetes mellitus (DM) patients undergoing isolated CABG. Methods We included a total of 634 diabetic patients undergoing CABG (60.5±9.1
years, 65.1% male) into this study, which was performed between September
2009 and January 2014 in a single center. The relation between preoperative
serum albumin levels and postoperative AKI development was observed. AKI was
evaluated and diagnosed using the Kidney Disease: Improving Global Outcomes
(KDIGO) classification. Results AKI was diagnosed in 230 (36.3%) patients. Multiple logistic regression
analysis was performed to determine the independent predictors of AKI
development. Proteinuria (odds ratio [OR] and 95% confidence interval [CI],
1.066 [1.002-1.135]; P=0.043) and low preoperative serum
albumin levels (OR and 95% CI, 0.453 [0.216-0.947];
P=0.035) were found to be independent predictors of AKI.
According to the receiver operating characteristic curve analysis, albumin
level <3mg/dL (area under the curve: 0.621 [0.572-0.669],
P<0.001) had 83% sensitivity and 10% specificity on
predicting the development of AKI. Conclusion We observed that a preoperative low serum albumin level was associated with
postoperative AKI development in patients with DM who underwent isolated
CABG procedure. We emphasize that this adjustable albumin level should be
considered before the operation since it is an easy and clinically
implementable management for the prevention of AKI development.
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Affiliation(s)
- Rezan Aksoy
- University of Health Sciences Kartal Kosuyolu Heart Education and Research Hospital Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Taylan Adademir
- University of Health Sciences Kartal Kosuyolu Heart Education and Research Hospital Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Ekrem Yilmaz
- University of Health Sciences Kartal Kosuyolu Heart Education and Research Hospital Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Deniz Cevirme
- University of Health Sciences Kartal Kosuyolu Heart Education and Research Hospital Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Sengor
- University of Health Sciences Kartal Kosuyolu Heart Education and Research Hospital Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Cengiz Koksal
- Bezmialem Vakıf University Medical Faculty Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, Bezmialem Vakıf University, Medical Faculty, Istanbul, Turkey
| | - Murat Bulent Rabus
- University of Health Sciences Kartal Kosuyolu Heart Education and Research Hospital Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
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Khoury H, Lyons R, Sanaiha Y, Rudasill S, Shemin RJ, Benharash P. Deep Venous Thrombosis and Pulmonary Embolism in Cardiac Surgical Patients. Ann Thorac Surg 2019; 109:1804-1810. [PMID: 31706868 DOI: 10.1016/j.athoracsur.2019.09.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 08/12/2019] [Accepted: 09/12/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Deep venous thrombosis and pulmonary embolism are life-threatening complications after surgery, warranting prophylaxis. However prophylaxis is not uniformly practiced among cardiac surgical patients. This study aimed to characterize the national incidence, mortality, and costs associated with thromboembolism after cardiac surgery. METHODS The 2005 to 2015 National Inpatient Sample was used to identify all adult patients undergoing coronary artery bypass grafting or valve surgery. International Classification of Disease codes were used to identify patients with deep venous thrombosis and pulmonary embolism. RESULTS Of approximately 3 million patients undergoing cardiac surgery, 1.62% developed deep venous thrombosis and 0.38% pulmonary embolism. Those with deep venous thrombosis and pulmonary embolism were more commonly women (33.2% and 36.2 vs 31.2%, P < .001), older (68.1 and 66.0% vs 65.7 years, P < .001), and had a higher Elixhauser comorbidity index (4.0 and 4.7 vs 3.7, P < .001). Deep venous thrombosis and pulmonary embolism were associated with increased mortality (4.95% and 14.8% vs 2.67%, P < .001). After adjustment for baseline differences, deep venous thrombosis was associated with an incremental increase in cost of $12,308, whereas pulmonary embolism was associated with $13,879 cost increase after cardiac surgery. Pulmonary embolism was an independent predictor of mortality (adjusted odds ratio, 3.39; 95% confidence interval, 2.74-4.18). CONCLUSIONS The mortality and financial burden related to thromboembolism in cardiac surgery are significant. Prophylaxis may be indicated in cardiac surgery patients to improve quality of care and reduce healthcare costs. Future controlled randomized trials investigating the benefit of thromboembolism prophylaxis in cardiac surgery are warranted.
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Affiliation(s)
- Habib Khoury
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California
| | - Robert Lyons
- Division of Cardiac Surgery, University of California Los Angeles, Los Angeles, California
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California; Division of Cardiac Surgery, University of California Los Angeles, Los Angeles, California
| | - Sarah Rudasill
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California
| | - Richard J Shemin
- Division of Cardiac Surgery, University of California Los Angeles, Los Angeles, California
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California; Division of Cardiac Surgery, University of California Los Angeles, Los Angeles, California.
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24
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Influence of left ventricular ejection fraction on morbidity and mortality after aortic root replacement. J Thorac Cardiovasc Surg 2019; 158:984-991.e1. [DOI: 10.1016/j.jtcvs.2018.10.147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 10/07/2018] [Accepted: 10/26/2018] [Indexed: 01/10/2023]
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25
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Merkle J, Daka A, Deppe AC, Wahlers T, Paunel-Görgülü A. High levels of cell-free DNA accurately predict late acute kidney injury in patients after cardiac surgery. PLoS One 2019; 14:e0218548. [PMID: 31211810 PMCID: PMC6581428 DOI: 10.1371/journal.pone.0218548] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/04/2019] [Indexed: 12/20/2022] Open
Abstract
Use of cardiopulmonary bypass in cardiac surgery triggers systemic inflammation by neutrophil activation leading to neutrophil extracellular traps (NETs) release. Hence, nuclear DNA released by necrotic and apoptotic cells might contribute to an increase in circulating cell-free DNA (cfDNA). cfDNA/NETs might induce endothelial damage and organ dysfunction. This study focuses on the accuracy of cfDNA to predict acute kidney injury (AKI) after on-pump surgery. 58 cardiac patients undergoing on-pump surgery were prospectively enrolled. Blood samples were taken preoperatively, immediately after surgery, at day 1, 2, 3 and 5 from patients with (n = 21) or without (n = 37) postoperative AKI development. Levels of cfDNA, neutrophil gelatinase-associated lipocalin (NGAL) and creatinine in patients’ plasma were quantified. ROC curves were used to assess the predictive value of the biomarkers for AKI. Further baseline characteristics and perioperative variables were analyzed.cfDNA and NGAL levels highly increased in AKI patients and significant intergroup differences (vs. non-AKI) were found until day 3 and day 5 after surgery, respectively. cfDNA levels were significantly elevated in patients who developed late AKI (>24 hours), but not in those with AKI development during the first 24 hours (early AKI). NGAL and creatinine, which were highest in patients with early AKI, accurately predicted during the first 24 postoperative hours (early AKI). At day 3, at a threshold of 260.53 ng/ml cfDNA was the best predictor for AKI (AUC = 0.804) compared to NGAL (AUC = 0.699) and creatinine (AUC = 0.688). NGAL, but not cfDNA, was strongly associated with AKI stages and mortality. Monitoring of cfDNA levels from the first postoperative day might represent a valuable tool to predict late AKI after on-pump surgery.
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Affiliation(s)
- Julia Merkle
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Aldo Daka
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Antje C. Deppe
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Adnana Paunel-Görgülü
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
- * E-mail:
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Abstract
Acute kidney injury (AKI) is a common and severe complication after cardiac
surgery. Currently, a series of novel biomarkers have favored the assessment of
AKI after cardiac surgery in addition to the conventional indicators. The
biomartkers, such as urinary liver fatty acid binding protein (L-FABP), urinary
neutrophil gelatinase-associated lipocalin (NGAL), serum L-FABP, heart-type
FABP, kidney injury molecule 1 (KIM-1), and interleukin-18 were found to be
significantly higher in patients who developed AKI after cardiac surgery than
those who did not. Apart from urinary interleukin-18, the novel biomarkers have
been recognized as reliable indicators for predicting the diagnosis, adverse
outcome, and even mortality of AKI after cardiac surgery. The timing of the
renal replacement therapy is a significant predictor relating to patients’
prognoses. In patients with AKI after cardiac surgery, renal replacement therapy
should be performed as early as possible in order to achieve promising outcomes.
In children, AKI after cardiac surgery can be managed with peritoneal dialysis.
AKI after cardiac surgery has received extensive attention as it may increase
early mortality and impact long-term survival of patients as well. The purpose
of this article was to analyze the changes of the pertinent biomarkers, to
explore the related risk factors leading to the occurrence of AKI after cardiac
surgery, and to provide a basis for the clinical prevention and reduction of
AKI.
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Affiliation(s)
- Shi-Min Yuan
- Fujian Medical University Teaching Hospital The First Hospital of Putian Putian Fujian Province People's Republic of China Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, People's Republic of China
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27
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Xu S, Liu J, Li L, Wu Z, Li J, Liu Y, Zhu J, Sun L, Guan X, Gong M, Zhang H. Cardiopulmonary bypass time is an independent risk factor for acute kidney injury in emergent thoracic aortic surgery: a retrospective cohort study. J Cardiothorac Surg 2019; 14:90. [PMID: 31064409 PMCID: PMC6505293 DOI: 10.1186/s13019-019-0907-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/22/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Thoracic aortic surgery and cardiopulmonary bypass are both associated with development of postoperative acute kidney injury. In this study, we undertook to investigate the relationship between cardiopulmonary bypass time and postoperative acute kidney injury in patients undergoing thoracic aortic surgery for acute DeBakey Type I aortic dissection. METHODS All patients receiving thoracic aortic surgery for acute DeBakey Type I aortic dissection in Beijing Anzhen hospital from December 2015 to April 2017 were included. Cardiopulmonary bypass time was recorded during surgery. Acute kidney injury was defined based on the Kidney Disease Improving Global Outcomes criteria. A total of 115 consecutive patients were eventually analyzed. RESULTS The overall incidence of acute kidney injury was 53.0% (n = 61). The average age was 47.8 ± 10.7 years; 74.8% were male. Mean cardiopulmonary bypass time was 211 ± 56 min. In-hospital mortality was 7.8%. Multivariate logistic regression revealed that cardiopulmonary bypass time was independently associated with the occurrence of postoperative acute kidney injury after adjust confounding factors (odds ratio = 1.171; 95% confidence interval: 1.002-1.368; P = 0.047). CONCLUSIONS Cardiopulmonary bypass time is independently associated with an increased hazard of acute kidney injury after thoracic aortic surgery for acute DeBakey Type I aortic dissection. Further understanding of the mechanism of this association is crucial to the design of preventative strategies.
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Affiliation(s)
- Shijun Xu
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, No.2 Anzhen Street, Beijing, 100029, China
| | - Jie Liu
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Lei Li
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, No.2 Anzhen Street, Beijing, 100029, China
| | - Zining Wu
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, No.2 Anzhen Street, Beijing, 100029, China
| | - Jiachen Li
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, No.2 Anzhen Street, Beijing, 100029, China
| | - Yongmin Liu
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, No.2 Anzhen Street, Beijing, 100029, China
| | - Junming Zhu
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, No.2 Anzhen Street, Beijing, 100029, China
| | - Lizhong Sun
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, No.2 Anzhen Street, Beijing, 100029, China
| | - Xinliang Guan
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, No.2 Anzhen Street, Beijing, 100029, China.
| | - Ming Gong
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, No.2 Anzhen Street, Beijing, 100029, China.
| | - Hongjia Zhang
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, No.2 Anzhen Street, Beijing, 100029, China.
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28
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Gorjipour F, Totonchi Z, Gholampour Dehaki M, Hosseini S, Tirgarfakheri K, Mehrabanian M, Mortazian M, Arasteh Manesh S, Rahab M, Shafighnia S, Taiyari S, Gorjipour F. Serum levels of interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor-α, renal function biochemical parameters and clinical outcomes in pediatric cardiopulmonary bypass surgery. Perfusion 2019; 34:651-659. [PMID: 31027462 DOI: 10.1177/0267659119842470] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Cardiopulmonary bypass causes detrimental effects on remote organs due to inflammatory response. One of these organs is kidney that is frequently affected by cardiac surgery. Acute kidney injury is a post-cardiopulmonary bypass complication, which may result in increased post-operative morbidity and mortality. Post-cardiopulmonary bypass inflammatory response may contribute to remote organ dysfunction. In the present study, we investigated the relation between cytokines including interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor-α, and renal function tests such as creatinine and blood urea nitrogen (BUN). METHODS In total, 91 patients between the ages of 4 and 60 months were enrolled for elective cardiac surgery with cardiopulmonary bypass after informed consent. Data regarding renal function tests and clinical outcomes were carefully recorded until 24 hours after admission to intensive care unit and analyzed. RESULTS Our findings support that there is a direct correlation between cytokines including interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor-α and cardiopulmonary bypass time, duration of operation, and intensive care unit stay. Longer cardiopulmonary bypass time was associated with higher interleukin-8 at cross-clamp removal and 24 hours post- intensive care unit as well as higher interleukin-10 at declamp time. Higher interleukin-6 at declamp time was directly correlated with higher post-operative BUN. Interleukin-8 level after anesthesia induction was directly correlated with intensive care unit stay duration. Higher blood interleukin-6 and tumor necrosis factor-α levels following 24 hours of admission to intensive care unit were associated with longer mechanical ventilation time. CONCLUSION Higher circulatory pro-inflammatory cytokine level is associated with adverse outcomes such as increased intensive care unit stay and longer mechanical ventilation time in pediatric patients. It is also correlated with unfavorable biochemical parameter of renal function, BUN. Findings hint that proper control of the inflammatory response is vital for the control of unfavorable clinical and pathological outcomes.
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Affiliation(s)
- Farhad Gorjipour
- Iranian Scientific Society of Extracorporeal Technology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ziya Totonchi
- Iranian Scientific Society of Extracorporeal Technology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maziar Gholampour Dehaki
- Iranian Scientific Society of Extracorporeal Technology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeid Hosseini
- Iranian Scientific Society of Extracorporeal Technology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Koroush Tirgarfakheri
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Mehdi Rahab
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Saeed Taiyari
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fazel Gorjipour
- Cellular and Molecular Research Center (CMRC), Iran University of Medical Sciences, Tehran, Iran
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29
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Gangadharan S, Sundaram KR, Vasudevan S, Ananthakrishnan B, Balachandran R, Cherian A, Varma PK, Gracia LB, Murukan K, Madaiker A, Jose R, Seetharaman R, Gopal K, Menon S, Thushara M, Jose RL, Deepak G, Vanga SB, Jayant A. Predictors of acute kidney injury in patients undergoing adult cardiac surgery. Ann Card Anaesth 2019; 21:448-454. [PMID: 30333348 PMCID: PMC6206792 DOI: 10.4103/aca.aca_21_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Acute kidney injury (AKI) after cardiac surgery (CS) is not uncommon and has serious effects on mortality and morbidity. A majority of patients suffer mild forms of AKI. There is a paucity of Indian data regarding this important complication after CS. Aims and Objectives The primary objective was to study the incidence of AKI associated with CS in an Indian study population. Secondary objectives were to describe the risk factors associated with AKI-CS in our population and to generate outcome data in patients who suffer this complication. Methods Serial patients (n = 400) presenting for adult CS (emergency/elective) at a tertiary referral care hospital in South India from August 2016 to November 2017 were included as the study individuals. The incidence of AKI-CS AKI network (AKIN criteria), risk factors associated with this condition and the outcomes following AKI-CS are described. Results Out of 400, 37 (9.25%) patients developed AKI after CS. AKI associated with CS was associated with a mortality of 13.5% (no AKI group mortality 2.8%, P = 0.001 [P < 0.05]). When AKI was severe enough to need renal replacement therapy, the mortality increased to 75%. Patients with AKI had a mean hospital stay 16.92 ± 12.75 days which was comparatively longer than patients without AKI (14 ± 7.98 days). Recent acute coronary syndrome, postoperative atrial fibrillation, and systemic hypertension significantly predicted the onset of AKI-CS in our population. Conclusions The overall incidence of AKI-CS was 9.25%. The incidence of AKI-CS requiring dialysis (Stage 3 AKIN) AKI-CS was lower (2%). However, mortality risks were disproportionately high in patients with AKIN Stage 3 AKI-CS (75%). There is a need for quality improvement in the care of patients with AKI-CS in its most severe forms since mortality risks posed by the development of Stage 3 AKIN AKI is higher than reported in other index populations from high resource settings.
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Affiliation(s)
- Sreja Gangadharan
- Department of Cardiac Anaesthesia, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - K R Sundaram
- Department of Biostatistics, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Senthilvelan Vasudevan
- Department of Biostatistics, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - B Ananthakrishnan
- Department of Cardiac Anaesthesia, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Rakhi Balachandran
- Department of Cardiac Anaesthesia, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Abraham Cherian
- Department of Cardiac Anaesthesia, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Praveen Kerala Varma
- Department of Cardiothoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Luis Bakero Gracia
- Department of Cardiothoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - K Murukan
- Department of Cardiothoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Ashish Madaiker
- Department of Cardiothoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Rajesh Jose
- Department of Cardiothoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Rakesh Seetharaman
- Department of Cardiothoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Kirun Gopal
- Department of Cardiothoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Sujatha Menon
- Department of Cardiac Anaesthesia, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - M Thushara
- Department of Cardiac Anaesthesia, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Reshmi Liza Jose
- Department of Cardiac Anaesthesia, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - G Deepak
- Department of Cardiac Anaesthesia, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Sudheer Babu Vanga
- Department of Cardiac Anaesthesia, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Aveek Jayant
- Department of Cardiac Anaesthesia, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
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30
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Mitochondrial Haplogroup and the Risk of Acute Kidney Injury Following Cardiac Bypass Surgery. Sci Rep 2019; 9:2279. [PMID: 30783114 PMCID: PMC6381211 DOI: 10.1038/s41598-018-37944-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 12/11/2018] [Indexed: 02/02/2023] Open
Abstract
Although mitochondrial dysfunction plays a key role in the pathophysiology of acute kidney injury (AKI), the influence of mitochondrial genetic variability in this process remains unclear. We explored the association between the risk of post-cardiac bypass AKI and mitochondrial haplotype - inherited mitochondrial genomic variations of potentially functional significance. Our single-centre study recruited consecutive patients prior to surgery. Exclusions included stage 5 CKD, non-Caucasian race and subsequent off-pump surgery. Haplogroup analysis allowed characterisation of the study population using the common mutations and by phylogenetic supergroup (WXI and HV). Chi-square tests for association allowed the identification of potential predictors of AKI for use in logistic regression analysis. AKI occurred in 12.8% of the study population (n = 881; male 69.6%, non-diabetic 78.5%, median (interquartile range) age 68.0 (61.0-75.0) years). The haplogroup profile comprised H (42.7%), J (12.1%), T (10.9%), U (14.4%) and K (7.6%). Although the regression model was statistically significant (χ2 = 95.483, p < 0.0005), neither the phylogenetic supergroups nor any individual haplogroup was a significant contributor. We found no significant association between common European haplogroups and the risk of post-cardiac bypass AKI. However, given the major role of mitochondrial dysfunction in AKI, there is a need to replicate our findings in other cohorts and with other aetiologies of AKI.
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31
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Pan JS, Sheikh-Hamad D. Mitochondrial dysfunction in acute kidney injury and sex-specific implications. MEDICAL RESEARCH ARCHIVES 2019; 7. [PMID: 31276028 DOI: 10.18103/mra.v7i2.1898] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The kidney is one of the most energy-demanding organs in the human body, and the maintenance of mitochondrial homeostasis is central to kidney function. Recent advances have led to a greater appreciation of how mitochondrial dysfunction contributes to the pathogenesis of AKI, from decreased ATP production, to enhanced mitochondrial oxidative stress, cell necrosis and apoptosis. Accumulating evidence suggests sexual dimorphism in the response to AKI with males demonstrating greater risk for developing ischemia-reperfusion and sepsis-induced kidney injury. In contrast, females may be more susceptible to nephrotoxic-AKI. There are important sex-related differences in mitochondrial respiration, biogenesis and dynamics that likely contribute to the observed sexual dimorphism in AKI. Sex hormones mediate many of these differences with multiple preclinical studies demonstrating the renoprotective actions of estrogen in many rodent models of AKI. Estrogenic control of mitochondrial biogenesis, function and reactive oxygen species (ROS) generation is discussed. Furthermore, the potential role for sex chromosomes in mediating sex differences in AKI is examined. Novel animal models such as the "four core genotypes" (FCG) mouse model provide us with important tools to study sex chromosome effects in kidney health and disease. By understanding the influences of sexual dimorphism or sex hormones on mitochondrial homeostasis and disease manifestations, we may be able to identify novel therapeutic targets and improve existing treatment options for AKI.
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Affiliation(s)
- Jenny S Pan
- Section of Nephrology and Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - David Sheikh-Hamad
- Section of Nephrology and Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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32
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Moore EM, Bellomo R, Nichol AD. The Meaning of Acute Kidney Injury and Its Relevance to Intensive Care and Anaesthesia. Anaesth Intensive Care 2019. [DOI: 10.1177/0310057x1204000604] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- E. M. Moore
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Student, Department of Epidemiology and Preventive Medicine, Monash University
| | - R. Bellomo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - A. D. Nichol
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Borde DP, Asegaonkar B, Apsingekar P, Khade S, Khodve B, Joshi S, George A, Pujari A, Deodhar A. Influence of time interval between coronary angiography to off-pump coronary artery bypass surgery on incidence of cardiac surgery associated acute kidney injury. Indian J Anaesth 2019; 63:475-484. [PMID: 31263300 PMCID: PMC6573058 DOI: 10.4103/ija.ija_770_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and Aims: Cardiac surgery associated acute kidney injury (CSA-AKI) is serious complication after cardiac surgery. The time interval between coronary angiography (CAG) to coronary artery bypass surgery (CABG) is proposed as modifiable risk factor for reduction of CSA-AKI. The aim of this study was to assess influence of time interval between CAG to off-pump CABG (OPCABG) on incidence of CSA-AKI. Methods: This was a retrospective observational study of 900 consecutive OPCABG patients who were classified into 2 groups based on time interval between CAG and OPCABG: ≤7 days or longer. Results: The incidence of CSA-AKI was 24% (214/900) by Kidney Disease: Improving Global Outcomes (KDIGO) definition. The incidence of CSA-AKI was not significantly different in two groups (22% in >7 days groupvs. 28% in ≤7 days group, P = 0.31). The factors independently associated with CSA-AKI were: Age (OR 1.04; P = 0.002), baseline creatinine (OR 1.99,; P = 0.03), moderate LV dysfunction (OR 1.64,; P = 0.007) and blood transfusion (OR 3.3,; P < 0.001), but not the time interval between CAG and OPCABG. The incidence of CSA-AKI was highest in patients with creatinine clearance (CC) <50 mL/min when OPCABG was performed ≤7 days of CAG (16/38; 42%, OR 2.7, 1.4-5.4; P = 0.005) compared to lowest incidence of CSA-AKI in patients with CC >50 mL/min and OPCABG performed >7 days of CAG (114/543; 21%). Conclusion: This study demonstrated that there is no increased incidence of CSA-AKI if OPCABG is performed ≤7 days of CAG; but we recommend to postpone OPCABG for seven days if CC is <50 mL/min and there is no urgent indication for OPCABG in order to reduce incidence of CSA-AKI.
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Affiliation(s)
- Deepak Prakash Borde
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Bengaluru, Karnataka, India
| | - Balaji Asegaonkar
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Bengaluru, Karnataka, India
| | - Pramod Apsingekar
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Bengaluru, Karnataka, India
| | - Sujeet Khade
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Bengaluru, Karnataka, India
| | - Bapu Khodve
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Bengaluru, Karnataka, India
| | - Shreedhar Joshi
- Department of Cardiac Anesthesia, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Antony George
- Department of Cardiac Anesthesia, Lissie Hospital, Kochi, Kerala, India
| | - Amey Pujari
- Department of Cardiac Surgery, United CIIGMA Hospital, Aurangabad, Maharashtra, India
| | - Anand Deodhar
- Department of Cardiac Surgery, United CIIGMA Hospital, Aurangabad, Maharashtra, India
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Kaufeld T, Foerster KA, Schilling T, Kielstein JT, Kaufeld J, Shrestha M, Haller HG, Haverich A, Schmidt BMW. Preoperative serum uric acid predicts incident acute kidney injury following cardiac surgery. BMC Nephrol 2018; 19:161. [PMID: 29973162 PMCID: PMC6031174 DOI: 10.1186/s12882-018-0970-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 06/26/2018] [Indexed: 12/01/2022] Open
Abstract
Background Acute kidney injury (AKI) following cardiac surgery is a frequent complication and several risk factors increasing its incidence have already been characterized. This study evaluates the influence of preoperative increased serum uric acid (SUA) levels in comparison with other known risk factors on the incidence of AKI following cardiac surgery. Methods During a period of 5 month, 247 patients underwent elective coronary artery bypass grafting, valve replacement/ repair or combined bypass and valve surgery. Datas were prospectively analyzed. Primary endpoint was the incidence of AKI as defined by the AKI criteria comparing patients with preoperative serum uric acid (SUA) levels below versus above the median. Multivariate logistic regression analysis was used to identify independent predictors of postoperative AKI. Results Thirty (12.1%) of the 247 patients developed postoperative AKI, 24 of 30 (80%) had preoperative SUA- levels above the median (≥373 μmol/l) (OR: 4.680, CI 95% 1.840; 11.904, p = 0.001). In the multivariate analysis SUA levels above the median (OR: 5.497, CI 95% 1.772; 17.054, p = 0.003), cardiopulmonary bypass (CPB) time > 90 min (OR: 4.595, CI 95% 1.587; 13.305, p = 0.005), cardiopulmonary bypass (CPB) > 30 kg/m2 (OR: 3.208, CI 95% 1.202; 8.562; p = 0.02), and preoperative elevated serum-creatinine levels (OR: 1.015, CI 95% 1.001; 1.029, p = 0.04) were independently associated with postoperative AKI. Conclusions Serum uric acid is an independent risk marker for AKI after cardiac surgery. From all evaluated factors it showed the highest odds ratio.
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Affiliation(s)
- T Kaufeld
- Department of Heart, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - K A Foerster
- Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg-Str.1, Hannover, 30625, Germany
| | - T Schilling
- Department of Heart, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - J T Kielstein
- Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg-Str.1, Hannover, 30625, Germany
| | - J Kaufeld
- Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg-Str.1, Hannover, 30625, Germany
| | - M Shrestha
- Department of Heart, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - H G Haller
- Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg-Str.1, Hannover, 30625, Germany
| | - A Haverich
- Department of Heart, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - B M W Schmidt
- Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg-Str.1, Hannover, 30625, Germany
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Lee HH, Kim SY, Na JC, Yoon YE, Han WK. Exogenous pentraxin-3 inhibits the reactive oxygen species-mitochondrial and apoptosis pathway in acute kidney injury. PLoS One 2018; 13:e0195758. [PMID: 29672566 PMCID: PMC5909599 DOI: 10.1371/journal.pone.0195758] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 03/28/2018] [Indexed: 11/18/2022] Open
Abstract
Pentraxin-3 (PTX3) is a long-form member of the pentraxin family of proteins that has been studied in inflammatory diseases and in various organs. We found that PTX3 protects kidney cells during ischemia and proinflammatory acute kidney injury. The aim of this study was to develop an in vitro experimental model of acute kidney injury and to analyze the protective mechanism of exogenous recombinant PTX3. In this study, cells of the HK-2 renal tubular cell line were treated with a calcium ionophore (A23187), which induced injury by increasing intracellular calcium concentrations and inducing calpain activity and the generation of reactive oxygen species. Exposure of cells to PTX3 significantly attenuated these effects. In addition, the activity of caspase-3 and PARP-1 were decreased in ischemic cells exposed to exogenous recombinant PTX3. PTX3 stabilized the mitochondrial membrane potential and suppressed apoptosis, resulting in the protection of renal tubular cells from ischemic injury.
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Affiliation(s)
- Hyung Ho Lee
- Department of Urology, National Health Insurance Service Ilsan Hospital, Gyeonggi-do, Korea
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sook Young Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Chae Na
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Eun Yoon
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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Zangrillo A, Alvaro G, Belletti A, Pisano A, Brazzi L, Calabrò MG, Guarracino F, Bove T, Grigoryev EV, Monaco F, Boboshko VA, Likhvantsev VV, Scandroglio AM, Paternoster G, Lembo R, Frassoni S, Comis M, Pasyuga VV, Navalesi P, Lomivorotov VV. Effect of Levosimendan on Renal Outcome in Cardiac Surgery Patients With Chronic Kidney Disease and Perioperative Cardiovascular Dysfunction: A Substudy of a Multicenter Randomized Trial. J Cardiothorac Vasc Anesth 2018; 32:2152-2159. [PMID: 29580796 DOI: 10.1053/j.jvca.2018.02.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Acute kidney injury (AKI) occurs frequently after cardiac surgery. Levosimendan might reduce the incidence of AKI in patients undergoing cardiac surgery. The authors investigated whether levosimendan administration could reduce AKI incidence in a high-risk cardiac surgical population. DESIGN Post hoc analysis of a multicenter randomized trial. SETTING Cardiac surgery operating rooms and intensive care units of 14 centers in 3 countries. PARTICIPANTS The study comprised 90 patients who underwent mitral valve surgery with an estimated glomerular filtration rate <60 mL/min/1.73 m2 and perioperative myocardial dysfunction. INTERVENTIONS Patients were assigned randomly to receive levosimendan (0.025-0.2 μg/kg/min) or placebo in addition to standard inotropic treatment. MEASUREMENTS AND MAIN RESULTS Forty-six patients were assigned to receive levosimendan and 44 to receive placebo. Postoperative AKI occurred in 14 (30%) patients in the levosimendan group versus 23 (52%) in the placebo group (absolute difference -21.8; 95% confidence interval -41.7 to -1.97; p = 0.035). The incidence of major complications also was lower (18 [39%]) in the levosimendan group versus that in the placebo group (29 [66%]) (absolute difference -26.8 [-46.7 to -6.90]; p = 0.011). A trend toward lower serum creatinine at intensive care unit discharge was observed in the levosimendan group (1.18 [0.99-1.49] mg/dL) versus that in the placebo group (1.39 [1.05-1.76] mg/dL) (95% confidence interval -0.23 [-0.49 to 0.01]; p = 0.07). CONCLUSIONS Levosimendan may improve renal outcome in cardiac surgery patients with chronic kidney disease undergoing mitral valve surgery who develop perioperative myocardial dysfunction. Results of this exploratory analysis should be investigated in future properly designed randomized controlled trials.
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Affiliation(s)
- Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Gabriele Alvaro
- Department of Anesthesia and Intensive Care, AOU Mater Domini Germaneto, Catanzaro, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Antonio Pisano
- Division of Cardiac Anesthesia and Intensive Care Unit, AORN dei Colli - Monaldi Hospital, Naples, Italy
| | - Luca Brazzi
- Department of Anesthesia and Intensive Care, AOU Città della Salute e della Scienza, Turin, Italy; Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Maria G Calabrò
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Guarracino
- Division of Cardiothoracic Anesthesia and Intensive Care, Department of Anesthesia and Critical Care Medicine, AOU Pisana, Pisa, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Evgeny V Grigoryev
- Department of Anesthesiology and Intensive Care, State Research Institute for Complex Issues of Cardiovascular Disease, Kemerovo, Russia
| | - Fabrizio Monaco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vladimir A Boboshko
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Valery V Likhvantsev
- Department of Anesthesiology and Intensive Care, Moscow Regional Clinical and Research Institute, Moscow, Russia
| | - Anna M Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Rosalba Lembo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Samuele Frassoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Comis
- Department of Cardiovascular Anesthesia and Intensive Care, AO Ordine Mauriziano, Turin, Italy
| | - Vadim V Pasyuga
- Department of Anesthesiology and Intensive Care, Federal Center for Cardiovascular Surgery Astrakhan, Astrakhan, Russia
| | - Paolo Navalesi
- Department of Anesthesia and Intensive Care, AOU Mater Domini Germaneto, Catanzaro, Italy; Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Vladimir V Lomivorotov
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
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Hua P, Liu J, Tao J, Lin X, Zou R, Zhang D, Yang S. Safety and efficacy of the perioperative administration of recombinant human brain natriuretic peptide (rhBNP): a systematic review and meta-analysis. Ther Clin Risk Manag 2018; 14:313-321. [PMID: 29503550 PMCID: PMC5824748 DOI: 10.2147/tcrm.s143247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective Retrospective studies and a meta-analysis were performed to evaluate the safety and effectiveness of the perioperative administration of recombinant human brain natriuretic peptide (rhBNP) during cardiac surgery under extracorporeal circulation. Methods Computerized literature searches were performed in Medline, Embase, The Cochrane Library, CNKI, CBM, and WANFANG to find randomized controlled trials (RCTs) related to the perioperative administration of rhBNP during cardiac surgery starting from the database inception until December 2016. Two researchers independently performed study screening, information extraction, and quality evaluation according to the inclusion/exclusion criteria, and a meta-analysis was performed using RevMan 5.2 software. Results A total of 12 studies were analyzed, including 12 RCTs and 727 patients. The meta-analysis results indicated that the perioperative administration of rhBNP could reduce the occurrence rate of postoperative complications, length of intensive care unit (ICU) stay, length of hospital stay, and serum creatinine (Scr) levels, and increase the 24-hour urine volume; however, it did not affect the postoperative mortality rate. Conclusion The perioperative administration of rhBNP during cardiac surgery was safe and effective, and could improve the prognosis of the patients.
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Affiliation(s)
- Ping Hua
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou
| | - Jianyang Liu
- Department of Vascular Surgery, Henan Provincial People's Hospital, Zhengzhou
| | - Jun Tao
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou
| | - Xifeng Lin
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou
| | - Rongjun Zou
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou
| | - Dingwen Zhang
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou
| | - Songran Yang
- The Biobank of Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou.,Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
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Abstract
Acute renal failure (ARF) in the ICU patient usually occurs as part of a wider multiple organ dysfunction, and is associated with mortality rates of around 50%. Differences in definitions make comparing study populations difficult and moves are being made to improve uniformity, and to recognize that ARF is not a single event but a continuous process from mild renal dysfunction through to complete organ failure requiring renal replacement therapy. In this review we will discuss the epidemiology of ARF within the limitations imposed by comparing studies that use different definitions and focus on different patient populations.
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Affiliation(s)
- J L Vincent
- Department of Intensive Care, Erasme University Hospital, Bruxelles, Belgium.
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Bellomo R, Auriemma S, Fabbri A, D'Onofrio A, Katz N, Mccullough P, Ricci Z, Shaw A, Ronco C. The Pathophysiology of Cardiac Surgery-Associated Acute Kidney Injury (CSA-AKI). Int J Artif Organs 2018; 31:166-78. [DOI: 10.1177/039139880803100210] [Citation(s) in RCA: 199] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Cardiac surgery associated acute kidney injury (CSA-AKI) is a significant clinical problem. Its pathogenesis is complex and multifactorial. It likely involved at least six major injury pathways: exogenous and endogenous toxins, metabolic factors, ischemia and reperfusion, neurohormonal activation, inflammation and oxidative stress. These mechanisms of injury are likely to be active at different times with different intensity and probably act synergistically. Because of such complexity and the small number of randomised controlled investigations in this field only limited recommendations can be made. Nonetheless, it appears important to avoid nephrotoxic drugs and desirable to avoid hyperglycemia in the peri-operative period. The duration of cardiopulmonary bypass should be limited whenever possible. Off-pump surgery, when indicated, may decrease the risk of AKI. Invasive hemodynamic monitoring focussed on attention to maintaining euvolemia, an adequate cardiac output and an adequate arterial blood pressure is desirable. Echocardiography may be useful in minimizing atheroembolic complications. The administration of N-acetylcysteine to protect the kidney from oxidative stress is not recommended. There is marked lack of randomised controlled trials in this field.
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Affiliation(s)
- R. Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne - Australia
| | - S. Auriemma
- Department of Cardiac Surgery, San Bortolo Hospital, Vicenza - Italy
| | - A. Fabbri
- Department of Cardiac Surgery, San Bortolo Hospital, Vicenza - Italy
| | - A. D'Onofrio
- Department of Cardiac Surgery, San Bortolo Hospital, Vicenza - Italy
| | - N. Katz
- Department of Surgery, Georgetown University Medical Center, Washington, DC - USA
| | - P.A. Mccullough
- Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan - USA
| | - Z. Ricci
- Department of Pediatric Cardiosurgery, Ospedale del Bambino Gesù, Rome - Italy
| | - A. Shaw
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina - USA
| | - C. Ronco
- Department of Nephrology, Dialysis and Transplantation, S. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
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Hoste E, Cruz D, Davenport A, Mehta R, Piccinni P, Tetta C, Viscovo G, Ronco C. The Epidemiology of Cardiac Surgery-Associated Acute Kidney Injury. Int J Artif Organs 2018; 31:158-65. [DOI: 10.1177/039139880803100209] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose To describe current knowledge on the epidemiology of cardiac surgery-associated acute kidney injury (CSA-AKI) and to formulate recommendations for clinical practice and a research agenda. Methods After a modified Delphi analysis by the Acute Dialysis Quality Initiative (ADQI), 4 questions on the epidemiology of CSA-AKI and recommendations for clinical practice and a research agenda were formulated and addressed. Results Existing studies on CSA-AKI use over 35 different definitions for CSA-AKI. In addition, there may be important differences in patient characteristics and procedures. This explains the significant variations in reported incidence. Most studies report on CSA-AKI as defined by the need for renal replacement therapy. However, even small decreases in kidney function are associated with a worsened outcome. The workgroup formulated the recommendation to use the AKIN consensus criteria for AKI. One should differentiate early CSA-AKI, caused by the procedure, and late CSA-AKI, associated with the procedure. There may be different clinical scenarios: acute on chronic CSA-AKI, AKI prior to CS, and AKI occurring post CS. Risk factors should be differentiated between pre-, intra-, and post-CS, and between patient-, process-, and procedure-related. Endpoints should include both short-term and long-term outcomes. Conclusions Existing data on the epidemiology of CSA-AKI are difficult to compare due to variations in definition and patient cohort. A modified Delphi analysis resulted in a series of recommendations for future research on CSA-AKI.
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Affiliation(s)
- E.A. Hoste
- Intensive Care Unit, Ghent University Hospital, Gent - Belgium
| | - D.N. Cruz
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - A. Davenport
- UCL Center for Nephrology, Royal Free and University College Medical School, London - UK
| | - R.L. Mehta
- UCSD Medical Center, San Diego, California - USA
| | - P. Piccinni
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - C. Tetta
- Division of Medicine, Fresenius Medical Care, Bad Homburg - Germany
| | - G. Viscovo
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - C. Ronco
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
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Differences and similarities in risk factors for postoperative acute kidney injury between younger and older adults undergoing cardiac surgery. J Thorac Cardiovasc Surg 2018; 155:256-265. [DOI: 10.1016/j.jtcvs.2017.08.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 08/01/2017] [Accepted: 08/18/2017] [Indexed: 11/23/2022]
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Rao SN, Shenoy M P, Gopalakrishnan M, Kiran B A. Applicability of the Cleveland clinic scoring system for the risk prediction of acute kidney injury after cardiac surgery in a South Asian cohort. Indian Heart J 2017; 70:533-537. [PMID: 30170649 PMCID: PMC6116709 DOI: 10.1016/j.ihj.2017.11.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/02/2017] [Accepted: 11/26/2017] [Indexed: 02/02/2023] Open
Abstract
Background Acute kidney injury (AKI) after cardiac surgery is a frequent post-operative complication associated with an increased risk of mortality, morbidity and hospital costs. Preoperative risk scores such as the Cleveland Clinic Scoring Tool (CCST) have been validated in Western population group to identify patients at higher risk of AKI and may facilitate preventive strategies. However, the scoring tool has not been validated systematically in a South Asian cohort. We aimed to evaluate the applicability of the CCST in prediction of AKI after open cardiac surgery in a South–Indian tertiary care center. Materials and methods A retrospective study of all patients who underwent elective open cardiac surgery over a 4 year period from Jan 2012 to Dec 2015 at a single centre were included and relevant details extracted from a comprehensive chart review. The primary outcome was AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Patients were risk stratified as per the CCST to assess for prediction of AKI into low risk (0–2), intermediate risk (3–5) and high risk (>6) groups. Results A total of 276 patients underwent open cardiac surgery with mean age of 51.5 ± 13.06 yrs. This included 177 (64.1%) males and 99 females (35.8%). Overall incidence of AKI was 6.88%. Mean age, gender, BMI, preoperative serum creatinine, diabetes mellitus, chronic obstructive pulmonary disease, cardiopulmonary bypass time was similar in patients who developed AKI vs those who did not have AKI postoperatively. The mean CCST scores were 1.6 in those without AKI, 1.5 in stage 1, 3.0 in stage 2 and 3.4 in stage 3 AKI. Higher risk scores predicted greater risk of AKI. A total of 106 patients (38.4%) were on ACE/ARB, 119 patients (43.1%) received beta-blockers, 110 (39.8%) received diuretics while 144(52.1%) had received preoperative statins. Comparison of drug use between the two groups revealed that preoperative use of ACEI/ARB was associated with highest risk of AKI (p = 0.006). Mortality rate was also high at 15.7% in those with AKI compared to 3.1% in non-AKI group (p = 0.04). Conclusion The modified CCST was valid in risk identification of patients with severe stage of AKI but did not have strong discrimination for early AKI stages. Preoperative statin use did not protect against AKI in our study, however preoperative ARB/ACEI use was significantly associated with occurrence of postoperative AKI.
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Affiliation(s)
- Shobhana Nayak Rao
- Deptartment of Nephrology, K.S.Hegde Medical Academy, Derlakatte, Mangalore, Karnataka, India.
| | - Pradeep Shenoy M
- Department of Cardiothoracic Surgery, K.S.Hegde Medical Academy, Derlakatte, Mangalore, Karnataka, India
| | - Mundayat Gopalakrishnan
- Department of Cardiothoracic Surgery, K.S.Hegde Medical Academy, Derlakatte, Mangalore, Karnataka, India
| | - Amith Kiran B
- Deptartment of Nephrology, K.S.Hegde Medical Academy, Derlakatte, Mangalore, Karnataka, India
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Gharaibeh KA, Hamadah AM, Sierra RJ, Leung N, Kremers WK, El-Zoghby ZM. The Rate of Acute Kidney Injury After Total Hip Arthroplasty Is Low but Increases Significantly in Patients with Specific Comorbidities. J Bone Joint Surg Am 2017; 99:1819-1826. [PMID: 29088036 DOI: 10.2106/jbjs.16.01027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the rate and risk factors associated with the development of acute kidney injury after total hip arthroplasty, including the perioperative use of nonsteroidal anti-inflammatory drugs (NSAIDs). METHODS We retrospectively collected the demographic and comorbidity data of all patients who underwent total hip arthroplasty between 2004 and 2014 at our institution (n = 8,949). We conducted analyses of the entire cohort and a nested case-control subset. Subjects who developed acute kidney injury were matched by age, sex, and year of surgical procedure to subjects without acute kidney injury. Variables associated with acute kidney injury were determined using univariate and multivariate logistic regressions. RESULTS The mean patient age (and standard deviation) was 64.6 ± 13.8 years, 48.6% of patients were male, and 114 cases (1.1%) developed acute kidney injury, mostly stage 1 (79%). Variables associated with acute kidney injury included older age (odds ratio [OR], 1.4 per decade; p < 0.001), male sex (OR, 1.78; p = 0.005), chronic kidney disease (OR, 4.6; p < 0.001), heart failure (OR, 4.5; p < 0.001), diabetes (OR, 2.1; p < 0.001), and hypertension (OR, 2.1; p = 0.007). The results were consistent in the case-control analysis. NSAIDs were not associated with acute kidney injury (OR, 1.26; p = 0.36), but were avoided in subjects at risk, making any interpretation difficult because of confounding. A risk model for acute kidney injury after total hip arthroplasty was developed for clinical use and had good discrimination (area under the curve, 0.82; p < 0.001). CONCLUSIONS The rate of acute kidney injury after total hip arthroplasty is low, but increases significantly, from <1% to >20%, in those with several independent risk factors present preoperatively. Increasing awareness of these risk factors may help to decrease the risk of acute kidney injury after total hip arthroplasty. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kamel A Gharaibeh
- 1Division of Nephrology and Hypertension, Department of Internal Medicine (K.A.G., A.M.H., N.L., and Z.M.El-Z.), and Departments of Orthopedic Surgery (R.J.S.) and Biomedical Statistics and Informatics (W.K.K.), Mayo Clinic, Rochester, Minnesota
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Wu HB, Ma WG, Zhao HL, Zheng J, Li JR, Liu O, Sun LZ. Risk factors for continuous renal replacement therapy after surgical repair of type A aortic dissection. J Thorac Dis 2017; 9:1126-1132. [PMID: 28523169 DOI: 10.21037/jtd.2017.03.128] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To identify the risk factors for continuous renal replacement therapy (CRRT) following surgical repair of type A aortic dissection (TAAD) using the total arch replacement and frozen elephant trunk (TAR + FET) technique. METHODS The study included 330 patients with TAAD repaired using TAR + FET between January 2014 and April 2015. Mean age was 47.1±10.2 years (range, 18-73 years) and 242 were male (73.3%). Univariate and multivariate analyses were used to identify the risk factors for CRRT. RESULTS Postoperative CRRT was required in 38 patients (mean age 50.7±10.0 years; 27 males). Operative death occurred in 12 patients (3.6%, 12/330). The mortality rate was 23.7% (9/38) in patients with CRRT and 1.0% (3/292) in those without CRRT (P<0.001). Factors associated with CRRT were age (50.7±10.0 vs. 46.7±10.2 years, P=0.023), preoperative serum creatinine (sCr) (135.0±154.2 vs. 85.7±37.0 µmol/L, P<0.001), emergency operation (89.5% vs. 73.3%, P=0.030), cardiopulmonary bypass (CPB) time (265.2±98.8 vs. 199.7±44.2 minutes, P<0.001), cross-clamp time (144.6±54.8 vs. 116.3±33.2 minutes, P<0.001), the amount of red blood cell (8.0±5.2 vs. 3.7±3.3 unit, P<0.001) and fresh frozen plasma (507.8±350.3 vs. 784.2±488.5 mL, P<0.001) transfused intraoperatively, preoperative D-dimmer level (11,361.0 vs. 2,856.7 mg/L, P<0.001) and reexploration for bleeding (15.8% vs. 2.4%, P<0.001). In multivariate analysis, risk factors for CRRT were CPB time (minute) [odds ratio (OR) 1.018; 95% confidence interval (CI), 1.007-1.029; P=0.002], preoperative sCr level (µmol/L) (OR, 1.008; 95% CI, 1.000-1.015; P=0.040), and the amount of red blood cell transfused intraoperatively (unit) (OR, 1.206; 95% CI, 1.077-1.350; P<0.001). CONCLUSIONS In this series of patients with TAAD, the time of CPB (minute), sCr level (µmol/L) and the amount of red blood cell transfused intraoperatively (unit) were risk factors for CRRT after TAR + FET.
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Affiliation(s)
- Hai-Bo Wu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China.,Beijing Engineering Research Center of Vascular Prostheses, Beijing 10029, China
| | - Wei-Guo Ma
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China.,Beijing Engineering Research Center of Vascular Prostheses, Beijing 10029, China
| | - Hong-Lei Zhao
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China.,Beijing Engineering Research Center of Vascular Prostheses, Beijing 10029, China
| | - Jun Zheng
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China.,Beijing Engineering Research Center of Vascular Prostheses, Beijing 10029, China
| | - Jian-Rong Li
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China.,Beijing Engineering Research Center of Vascular Prostheses, Beijing 10029, China
| | - Ou Liu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China.,Beijing Engineering Research Center of Vascular Prostheses, Beijing 10029, China
| | - Li-Zhong Sun
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China.,Beijing Engineering Research Center of Vascular Prostheses, Beijing 10029, China
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Ortega-Loubon C, Fernández-Molina M, Carrascal-Hinojal Y, Fulquet-Carreras E. Cardiac surgery-associated acute kidney injury. Ann Card Anaesth 2017; 19:687-698. [PMID: 27716701 PMCID: PMC5070330 DOI: 10.4103/0971-9784.191578] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a well-recognized complication resulting with the higher morbid-mortality after cardiac surgery. In its most severe form, it increases the odds ratio of operative mortality 3-8-fold, length of stay in the Intensive Care Unit and hospital, and costs of care. Early diagnosis is critical for an optimal treatment of this complication. Just as the identification and correction of preoperative risk factors, the use of prophylactic measures during and after surgery to optimize renal function is essential to improve postoperative morbidity and mortality of these patients. Cardiopulmonary bypass produces an increased in tubular damage markers. Their measurement may be the most sensitive means of early detection of AKI because serum creatinine changes occur 48 h to 7 days after the original insult. Tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 are most promising as an early diagnostic tool. However, the ideal noninvasive, specific, sensitive, reproducible biomarker for the detection of AKI within 24 h is still not found. This article provides a review of the different perspectives of the CSA-AKI, including pathogenesis, risk factors, diagnosis, biomarkers, classification, postoperative management, and treatment. We searched the electronic databases, MEDLINE, PubMed, EMBASE using search terms relevant including pathogenesis, risk factors, diagnosis, biomarkers, classification, postoperative management, and treatment, in order to provide an exhaustive review of the different perspectives of the CSA-AKI.
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Abstract
This study aimed to investigate the outcomes of acute kidney injury (AKI) after cardiac surgery by the meta-analysis.Electronic databases PubMed and Embase were searched for relative studies from December 2008 to June 2015. For eligible studies, the R software was conducted to meta-analyze outcomes of AKI patients (AKI group) and none-AKI patients after cardiac surgery (NO AKI group). The chi-square-based Q test and I statistic were used for heterogeneity analysis. P < 0.1 or I > 50% revealed significant heterogeneity among studies, and then a random effects model was used; otherwise a fixed effect model was performed. Egger's test was performed for publication bias assessment. Subgroup analysis was performed by stratifying AKI definitions and study type.Totally 17 studies with 9656 subjects (2331 in the AKI group and 7325 in the NO AKI group) were enrolled. Significantly higher renal replacement therapy (RRT) (OR=23.67, 95%CI: 12.58-44.55), mortality (OR = 6.27, 95%CI: 3.58-11.00), serum creatinine (SMD = 1.42, 95%CI: 1.01-1.83), and hospital length of stay (LOS) (SMD = 0.45, 95%CI: 0.02-0.88) were shown in the AKI group compared with patients in the NO AKI group. Subgroup analysis showed that results of only 3 subgroups were reversed indicating that the definition of AKI did not affect its outcomes. Publication bias was only found among studies involving mortality and serum creatinine, but the 2 outcomes were not reversed after correction.This meta-analysis confirmed the worse outcomes of AKI in patients after cardiac surgery, including higher RRT rates, mortality, and longer hospital LOS than those of NO AKI patients.
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Affiliation(s)
| | | | - Xinwei Mu
- Department of Critical Care Medicine
| | - Cui Zhang
- Department of Critical Care Medicine
| | - Xin Chen
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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Dayan V, Stanham R, Soca G, Genta F, Mariño J, Lorenzo A. Early surgery after angiography in patients scheduled for valve replacement. Asian Cardiovasc Thorac Ann 2016; 25:18-23. [PMID: 28074703 DOI: 10.1177/0218492316680496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background There are limited data regarding the risks of cardiac surgery early after coronary angiography in patients scheduled for isolated aortic and/or mitral valve replacement. Our aim was to evaluate the risk of early surgery after coronary angiography in these patients. Methods We retrospectively analyzed data of 1044 patients who underwent isolated aortic and/or mitral valve replacement from 2006 to 2014. Baseline, operative, and postoperative variables were collected. The patients were divided into 3 groups based on the interval between coronary angiography and surgery: ≤3 days ( n = 216), 4-7 days ( n = 109), and ≥8 days ( n = 719). We evaluated hospital mortality and postoperative acute kidney injury. Subgroup analysis was performed according to preoperative creatinine clearance. Results Postoperative creatinine clearance was lower in patients who underwent surgery ≤3 days after coronary angiography (63.57 ± 38.52 mL min-1) compared to ≥8 days after coronary angiography (74.56 ± 54.25 mL min-1, p = 0.015). Patients who underwent surgery ≤3 days after coronary angiography had higher hospital mortality when preoperative creatinine clearance was ≤60 mL min-1 (12% vs. 4% for creatinine clearance ≤and >60 mL min-1, respectively; p = 0.039). Predictors of hospital mortality were New York Heart Association class and postoperative creatinine clearance. Conclusion Hospital mortality was higher in patients with decreased preoperative renal function who underwent surgery within the first 3 days after coronary angiography. Delaying surgery in this subgroup of patients could be a good strategy.
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Affiliation(s)
- Victor Dayan
- National Institute of Cardiac Surgery, Montevideo, Uruguay
| | | | - Gerardo Soca
- National Institute of Cardiac Surgery, Montevideo, Uruguay
| | - Fernando Genta
- National Institute of Cardiac Surgery, Montevideo, Uruguay
| | - Jorge Mariño
- National Institute of Cardiac Surgery, Montevideo, Uruguay
| | - Alvaro Lorenzo
- National Institute of Cardiac Surgery, Montevideo, Uruguay
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Yoshitake I, Sezai A, Hata M, Osaka S, Kimura H, Hata H, Shiono M. Renin-Angiotensin System Control for Chronic Kidney Disease Patients Undergoing Coronary Surgery. Ann Thorac Cardiovasc Surg 2016; 22:291-297. [PMID: 27558882 DOI: 10.5761/atcs.oa.16-00105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE We investigated the effectiveness of active renin-angiotensin-aldosterone system (RAAS) control with human atrial natriuretic peptide (hANP) and an angiotensin II receptor blocker (ARB) in patients with chronic kidney disease (CKD) undergoing coronary artery bypass grafting (CABG). METHODS A total of 286 consecutive patients with CKD undergoing CABG were divided into three groups: Group C (n = 50) receiving placebo, the hANP group (n = 60) receiving hANP, and the active RAAS control therapy (ARC) group (n = 56) receiving hANP plus an ARB. Renal function, brain natriuretic peptide (BNP) and RAAS parameters were analyzed. RESULTS After 1 year, renal function parameters were better in the hANP and ARC groups compared with group C, and the dialysis rate was significantly lower (group C: 12%, hANP group: 1.7%, ARC group: 1.8%, p = 0.018) in the hANP and ARC groups. BNP levels were significantly lower in the hANP and ARC groups compared with group C (p = 0.001). There was also a significant difference of aldosterone among the groups (p = 0.023), as well as a significant difference between group C and the ARC group (p = 0.017). CONCLUSIONS The present study showed that active RAAS control preserved renal function in patients with CKD undergoing CABG. The improved early postoperative outcome with RAAS control may lead to long-term inhibition of cardiovascular events.
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Affiliation(s)
- Isamu Yoshitake
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
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Pieri M, Belletti A, Monaco F, Pisano A, Musu M, Dalessandro V, Monti G, Finco G, Zangrillo A, Landoni G. Outcome of cardiac surgery in patients with low preoperative ejection fraction. BMC Anesthesiol 2016; 16:97. [PMID: 27760527 PMCID: PMC5069974 DOI: 10.1186/s12871-016-0271-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/12/2016] [Indexed: 01/28/2023] Open
Abstract
Background In patients undergoing cardiac surgery, a reduced preoperative left ventricular ejection fraction (LVEF) is common and is associated with a worse outcome. Available outcome data for these patients address specific surgical procedures, mainly coronary artery bypass graft (CABG). Aim of our study was to investigate perioperative outcome of surgery on patients with low pre-operative LVEF undergoing a broad range of cardiac surgical procedures. Methods Data from patients with pre-operative LVEF ≤40 % undergoing cardiac surgery at a university hospital were reviewed and analyzed. A subgroup analysis on patients with pre-operative LVEF ≤30 % was also performed. Results A total of 7313 patients underwent cardiac surgery during the study period. Out of these, 781 patients (11 %) had a pre-operative LVEF ≤40 % and were included in the analysis. Mean pre-operative LVEF was 33.9 ± 6.1 % and in 290 patients (37 %) LVEF was ≤30 %. The most frequently performed operation was CABG (31 % of procedures), followed by mitral valve surgery (22 %) and aortic valve surgery (19 %). Overall perioperative mortality was 5.6 %. Mitral valve surgery was more frequent among patients who did not survive, while survivors underwent more frequently CABG. Post-operative myocardial infarction occurred in 19 (2.4 %) of patients, low cardiac output syndrome in 271 (35 %). Acute kidney injury occurred in 195 (25 %) of patients. Duration of mechanical ventilation was 18 (12–48) hours. Incidence of complications was higher in patients with LVEF ≤30 %. Stepwise multivariate analysis identified chronic obstructive pulmonary disease, pre-operative insertion of intra-aortic balloon pump, and pre-operative need for inotropes as independent predictors of mortality among patients with LVEF ≤40 %. Conclusions We confirmed that patients with low pre-operative LVEF undergoing cardiac surgery are at higher risk of post-operative complications. Cardiac surgery can be performed with acceptable mortality rates; however, mitral valve surgery, was found to be associated with higher mortality rates in this population. Accurate selection of patients, risk/benefit evaluation, and planning of surgical and anesthesiological management are mandatory to improve outcome. Electronic supplementary material The online version of this article (doi:10.1186/s12871-016-0271-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marina Pieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Fabrizio Monaco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Antonio Pisano
- Cardiac Anesthesia and Intensive Care Unit, Monaldi Hospital A.O.R.N. "Dei Colli", Naples, Italy
| | - Mario Musu
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy
| | - Veronica Dalessandro
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Giacomo Monti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Gabriele Finco
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
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Thongprayoon C, Cheungpasitporn W, Gillaspie EA, Greason KL, Kashani KB. Association of blood transfusion with acute kidney injury after transcatheter aortic valve replacement: A meta-analysis. World J Nephrol 2016; 5:482-8. [PMID: 27648412 PMCID: PMC5011255 DOI: 10.5527/wjn.v5.i5.482] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 04/23/2016] [Accepted: 06/27/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To assess red blood cell (RBC) transfusion effects on acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR). METHODS A literature search was performed using MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and clinicaltrials.gov from the inception of the databases through December 2015. Studies that reported relative risk, odds ratio or hazard ratio comparing the risks of AKI following TAVR in patients who received periprocedural RBC transfusion were included. Pooled risk ratio (RR) and 95%CI were calculated using a random-effect, generic inverse variance method. RESULTS Sixteen cohort studies with 4690 patients were included in the analyses to assess the risk of AKI after TAVR in patients who received a periprocedural RBC transfusion. The pooled RR of AKI after TAVR in patients who received a periprocedural RBC transfusion was 1.95 (95%CI: 1.56-2.43) when compared with the patients who did not receive a RBC transfusion. The meta-analysis was then limited to only studies with adjusted analysis for confounders assessing the risk of AKI after TAVR; the pooled RR of AKI in patients who received periprocedural RBC transfusion was 1.85 (95%CI: 1.29-2.67). CONCLUSION Our meta-analysis demonstrates an association between periprocedural RBC transfusion and a higher risk of AKI after TAVR. Future studies are required to assess the risks of severe AKI after TAVR requiring renal replacement therapy and mortality in the patients who received periprocedural RBC transfusion.
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