Lower body ischaemic time is a risk factor for acute kidney injury after surgery for type A acute aortic dissection
Lower body ischaemic time is a risk factor for acute kidney injury after surgery for type A acute aortic dissection
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DOI：
10.1093/icvts/ivz220
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发表时间：
2020-01-01
影响因子：
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通讯作者：
Takagi, Yasushi
中科院分区：
文献类型：
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作者：
Amano, Kentaro;Takami, Yoshiyuki;Takagi, Yasushi
目的：术后急性肾损伤（AKI）被认为是斯坦福a型急性主动脉夹层手术后低温循环停止后死亡的危险因素。它也可能对长期生存产生不利影响。我们寻找术后AKI可改变的危险因素，重点关注下体缺血时间。方法：我们回顾了191例Stanford A型急性主动脉夹层手术修复患者。远端吻合依赖于排除原撕裂位置，导致升弓/半弓（n = 119）、部分弓（n = 18）和全弓置换（n = 54）。我们将血清肌酐水平升高至基线水平的2倍定义为AKI。对AKI的发生率进行多因素分析。结果：49例患者（26%）出现术后AKI，其中31%需要肾脏替代治疗。医院总死亡率为8.5%。术后AKI、术前休克和器官灌注不良是院内死亡的预测因素。多因素逐步logistic回归分析发现，年龄、体重指数、术前慢性肾脏疾病和下体缺血时间是术后AKI的危险因素。结论：尽管Stanford A型急性主动脉夹层的手术修复效果良好，但术后AKI的发生率仍然很高，与住院死亡密切相关。下体缺血时间应被明确认为是术后AKI可改变的手术危险因素。
OBJECTIVES: Postoperative acute kidney injury (AKI) is known as a risk factor for death after surgery for Stanford type A acute aortic dissection under hypothermic circulatory arrest. It may also adversely affect long-term survival. We searched for modifiable risk factors for postoperative AKI, focusing on lower body ischaemic time.METHODS: We reviewed 191 patients undergoing surgical repair for Stanford type A acute aortic dissection. The distal anastomosis depended on excluding the primary tear location, resulting in ascending/hemiarch (n = 119), partial arch (n = 18) and total arch replacement (n = 54). We defined an increase in the serum creatinine level to >= 2 times the baseline level as AKI. The incidence of AKI was investigated with multivariate analysis of its risk factors.RESULTS: Postoperative AKI was observed in 49 patients (26%), 31% of whom required renal replacement therapy. The overall hospital mortality rate was 8.5%. Postoperative AKI, preoperative shock and organ malperfusion were predictors of hospital death. Multivariate stepwise logistic regression analysis identified age, body mass index, preoperative chronic kidney disease and lower body ischaemic time as risk factors for postoperative AKI.CONCLUSIONS: Although surgical repair for Stanford type A acute aortic dissection showed favourable results, the incidence of postoperative AKI is still high, closely associated with hospital death. Lower body ischaemic time should be recognized specifically as a modifiable surgical risk factor for postoperative AKI.