Abstract
BackgroundAcute kidney injury (AKI) is a major postoperative morbidity of patients undergoing cardiac surgery and has a negative effect on prognosis. The kidney outcomes after pulmonary endarterectomy (PEA) have not yet been reported; However, several perioperative characteristics of PEA may induce postoperative AKI. The objective of our study was to identify the incidence and risk factors for postoperative AKI and its association with short-term outcomes.MethodsThis was a single-center, retrospective, observational, cohort study. Assessments of AKI diagnosis was executed based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria.ResultsA total of 123 consecutive patients who underwent PEA between 2014 and 2018 were included.The incidence of postoperative AKI was 45% in the study population. Stage 3 AKI was associated with worse short-term outcomes and 90-day mortality (p < 0.001, p = 0.002, respectively). The independent predictors of postoperative AKI were the preoperative platelet count (OR 0.992; 95%CI 0.984–0.999; P = 0.022), preoperative hemoglobin concentration (OR 0.969; 95%CI 0.946–0.993; P = 0.01) and deep hypothermic circulatory arrest (DHCA) time (OR 1.197; 95%CI 1.052–1.362; P = 0.006) in the multivariate analysis.ConclusionThe incidence of postoperative AKI was relatively high after PEA compared with other types of cardiothoracic surgeries. The preoperative platelet count, preoperative hemoglobin concentration and DHCA duration were modifiable predictors of AKI, and patients may benefit from some low-risk, low-cost perioperative measures.
Highlights
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare chronic form of pulmonary hypertension (PH) characterized by pathological changes in the pulmonary arteries and the presence of an occlusive tissue thromboembolism in the arterial lumen
Concerning risk factors for CTEPH, 26 (21.1%) patients had acute pulmonary embolism, 49 (39.8%) patients were diagnosed with deep venous embolism, 9 (7.3%) patients were diagnosed with antiphospholipid syndrome, and 17 (13.8%) patients had a history of acute thrombolysis
We demonstrated an incidence of 45% of postoperative Acute kidney injury (AKI) after pulmonary endarterectomy (PEA) and reported a 3.3% rate of renal replacement therapy (RRT) in our study, which is similar to the results of previous studies on cardiothoracic surgery under deep hypothermic circulatory arrest (DHCA)
Summary
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare chronic form of pulmonary hypertension (PH) characterized by pathological changes in the pulmonary arteries and the presence of an occlusive tissue thromboembolism in the arterial lumen. The incidence of CTEPH is 3–30 per million in the general population and 0.4 to 9.1% in acute pulmonary embolism survivors [5]. In the setting of surgery, a complete bilateral pulmonary thromboendarterectomy with cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) offers these patients the best chance of improved long-term outcomes. Acute kidney injury (AKI) is a major postoperative morbidity of patients undergoing cardiac surgery and has a negative effect on prognosis. The kidney outcomes after pulmonary endarterectomy (PEA) have not yet been reported; several perioperative characteristics of PEA may induce postoperative AKI. The objective of our study was to identify the incidence and risk factors for postoperative AKI and its association with short-term outcomes
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