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

Kentaro Amano, Yoshiyuki Takami, Hiroshi Ishikawa, Michiko Ishida, Masato Tochii, Kiyotoshi Akita, Yusuke Sakurai, Mika Noda, Yasushi Takagi

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

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

Original languageEnglish
Pages (from-to)107-112
Number of pages6
JournalInteractive Cardiovascular and Thoracic Surgery
Volume30
Issue number1
DOIs
Publication statusPublished - 01-01-2020

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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