Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Apr;9(4):1126-1132.
doi: 10.21037/jtd.2017.03.128.

Risk factors for continuous renal replacement therapy after surgical repair of type A aortic dissection

Hai-Bo Wu  1   2 , Wei-Guo Ma  1   2 , Hong-Lei Zhao  1   2 , Jun Zheng  1   2 , Jian-Rong Li  1   2 , Ou Liu  1   2 , Li-Zhong Sun  1   2
Affiliations

Risk factors for continuous renal replacement therapy after surgical repair of type A aortic dissection

Hai-Bo Wu et al. J Thorac Dis. 2017 Apr.

Abstract

Background: To identify the risk factors for continuous renal replacement therapy (CRRT) following surgical repair of type A aortic dissection (TAAD) using the total arch replacement and frozen elephant trunk (TAR + FET) technique.

Methods: The study included 330 patients with TAAD repaired using TAR + FET between January 2014 and April 2015. Mean age was 47.1±10.2 years (range, 18-73 years) and 242 were male (73.3%). Univariate and multivariate analyses were used to identify the risk factors for CRRT.

Results: Postoperative CRRT was required in 38 patients (mean age 50.7±10.0 years; 27 males). Operative death occurred in 12 patients (3.6%, 12/330). The mortality rate was 23.7% (9/38) in patients with CRRT and 1.0% (3/292) in those without CRRT (P<0.001). Factors associated with CRRT were age (50.7±10.0 vs. 46.7±10.2 years, P=0.023), preoperative serum creatinine (sCr) (135.0±154.2 vs. 85.7±37.0 µmol/L, P<0.001), emergency operation (89.5% vs. 73.3%, P=0.030), cardiopulmonary bypass (CPB) time (265.2±98.8 vs. 199.7±44.2 minutes, P<0.001), cross-clamp time (144.6±54.8 vs. 116.3±33.2 minutes, P<0.001), the amount of red blood cell (8.0±5.2 vs. 3.7±3.3 unit, P<0.001) and fresh frozen plasma (507.8±350.3 vs. 784.2±488.5 mL, P<0.001) transfused intraoperatively, preoperative D-dimmer level (11,361.0 vs. 2,856.7 mg/L, P<0.001) and reexploration for bleeding (15.8% vs. 2.4%, P<0.001). In multivariate analysis, risk factors for CRRT were CPB time (minute) [odds ratio (OR) 1.018; 95% confidence interval (CI), 1.007-1.029; P=0.002], preoperative sCr level (µmol/L) (OR, 1.008; 95% CI, 1.000-1.015; P=0.040), and the amount of red blood cell transfused intraoperatively (unit) (OR, 1.206; 95% CI, 1.077-1.350; P<0.001).

Conclusions: In this series of patients with TAAD, the time of CPB (minute), sCr level (µmol/L) and the amount of red blood cell transfused intraoperatively (unit) were risk factors for CRRT after TAR + FET.

Keywords: Renal failure; aortic dissection (AD); blood transfusion; continuous renal replacement therapy (CRRT); risk factor; treatment outcome.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

References

    1. Hobson CE, Yavas S, Segal MS, et al. Acute kidney injury is associated with increased long-term mortality after cardiothoracic surgery. Circulation 2009;119:2444-53. 10.1161/CIRCULATIONAHA.108.800011 - DOI - PubMed
    1. Kuitunen A, Vento A, Suojaranta-Ylinen R, et al. Acute renal failure after cardiac surgery: evaluation of the RIFLE classification. Ann Thorac Surg 2006;81:542-6. 10.1016/j.athoracsur.2005.07.047 - DOI - PubMed
    1. Kim MY, Jang HR, Huh W, et al. Incidence, risk factors, and prediction of acute kidney injury after off-pump coronary artery bypass grafting. Ren Fail 2011;33:316-22. 10.3109/0886022X.2011.560406 - DOI - PubMed
    1. Chertow GM, Levy EM, Hammermeister KE, et al. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med 1998;104:343-8. 10.1016/S0002-9343(98)00058-8 - DOI - PubMed
    1. Englberger L, Suri RM, Greason KL, et al. Deep hypothermic circulatory arrest is not a risk factor for acute kidney injury in thoracic aortic surgery. J Thorac Cardiovasc Surg 2011;141:552-8. 10.1016/j.jtcvs.2010.02.045 - DOI - PubMed

LinkOut - more resources