Invited Commentary

Abstract

Acute kidney injury (AKI) is a well-established postoperative complication with often devastating consequences. Yamauchi and colleagues [1Yamauchi T. Miyagawa S. Yoshikawa Y. et al.Risk index for postoperative acute kidney injury after valvular surgery using cardiopulmonary bypass.Ann Thorac Surg. 2017; 104: 868-876Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar] present a predicative model for AKI following valvular cardiac surgery. Though retrospective, this review of 1484 patients is sizeable. Despite our current practice patterns and overall excellent outcomes, AKI remains a frustrating source of morbidity and mortality. This was reflected in the article, in which the new onset of dialysis dependency resulted in a 49% in-hospital death rate. The independent risk factors associated with AKI were smoking, diabetes mellitus, arteriosclerosis obliterans, congestive heart failure, preexisting renal insufficiency, and prolonged operative time. Interestingly operative time, especially longer than 8 hours, rather than prolonged cardiopulmonary bypass was highly predictive of AKI. This was likely a surrogate for adverse intraoperative events or complex surgery that provoked a deleterious inflammatory response. By assigning weight to each variable, a predictive model was created. The incidence of AKI in the low-, medium-, and high-risk groups was 1.8%, 7.5%, and 29% respectively. This article warrants merit for the large number of cases reviewed and because it focuses specifically on valvular surgery. Hopefully the application of the model should help to identify at-risk patients for whom hemodynamic optimization should be considered before, during, and after surgery. Risk Index for Postoperative Acute Kidney Injury After Valvular Surgery Using Cardiopulmonary BypassThe Annals of Thoracic SurgeryVol. 104Issue 3PreviewAcute kidney injury (AKI) after valvular surgical procedures with cardiopulmonary bypass carries potentially high mortality and morbidity rates. This study investigated the risk factors for AKI, and the study investigators developed a risk index to predict postoperative AKI. Full-Text PDF