Abstract
BackgroundThoracic 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.MethodsAll 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.ResultsThe 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).ConclusionsCardiopulmonary 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.
Highlights
Acute kidney injury (AKI) is frequent as a serious complication following operation for acute DeBakey Type I aortic dissection (ADTIAD)
A total of 18 patients requiring renal replacement therapy (RRT) before surgery were excluded for the difficulty to evaluate the progression of renal dysfunction and three patients who died intraoperatively or within 24 h after operation were excluded because no useful data were available to evaluate the AKI
Multivariable analysis to assess the independent impact of Cardiothoracic Surgery (2019) 14:90Cardiopulmonary bypass (CPB) time on postoperative AKI in patients with ADTIAD using non-adjusted and adjusted logistic regression model Table 3 revealed the results of multivariate logistic regression analysis models for AKI based on different variable categories included in each analysis
Summary
Acute kidney injury (AKI) is frequent as a serious complication following operation for acute DeBakey Type I aortic dissection (ADTIAD). Cardiopulmonary bypass (CPB) is necessary to facilitate surgical correction of ADTIAD. It can result in significant inflammation and oxidant stress response which contribute to multi-organ dysfunction. Studies examining the association between CPB time and postoperative AKI in patients undergoing thoracic aortic surgery for ADTIAD have not been extensive. Thoracic aortic surgery and cardiopulmonary bypass are both associated with development of postoperative acute kidney injury. 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
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