Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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The Risk Factors and Outcomes of Acute Kidney Injury after Thoracic Endovascular Aortic Repair

  • Jeon, Yun-Ho (Department of Thoracic and Cardiovascular Surgery, Catholic University of Daegu School of Medicine) ;
  • Bae, Chi-Hoon (Department of Thoracic and Cardiovascular Surgery, Catholic University of Daegu School of Medicine)
  • Received : 2015.07.06
  • Accepted : 2015.09.14
  • Published : 2016.02.05
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Abstract

Background: We aimed to evaluate the incidence, predictive factors, and impact of acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR). Methods: A total of 53 patients who underwent 57 TEVAR operations between 2008 and 2015 were reviewed for the incidence of AKI as defined by the RIFLE (risk, injury, failure, loss, and end-stage kidney disease risk) consensus criteria. The estimated glomerular filtration rate was determined in the perioperative period. Comorbidities and postoperative outcomes were retrospectively reviewed. Results: Underlying aortic pathologies included 21 degenerative aortic aneurysms, 20 blunt traumatic aortic injuries, six type B aortic dissections, five type B intramural hematomas, three endoleaks and two miscellaneous diseases. The mean age of the patients was $61.2{\pm}17.5years$ (range, 15 to 85 years). AKI was identified in 13 (22.8%) of 57 patients. There was an association of preoperative stroke and postoperative paraparesis and paraplegia with AKI. The average intensive care unit (ICU) stay in patients with AKI was significantly longer than in patients without AKI (5.3 vs. 12.7 days, p=0.017). The 30-day mortality rate in patients with AKI was significantly higher than patients without AKI (23.1% vs. 4.5%, p=0.038); however, AKI did not impact long-term survival. Conclusion: Preoperative stroke and postoperative paraparesis and paraplegia were identified as predictors for AKI. Patients with AKI experienced longer average ICU stays and greater 30-day mortality than those without AKI. Perioperative identification of high-risk patients, as well as nephroprotective strategies to reduce the incidence of AKI, should be considered as important aspects of a successful TEVAR procedure.

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References

  1. Pisimisis GT, Khoynezhad A, Bashir K, Kruse MJ, Donayre CE, White RA. Incidence and risk factors of renal dysfunction after thoracic endovascular aortic repair. J Thorac Cardiovasc Surg 2010;140(6 Suppl):S161-7. https://doi.org/10.1016/j.jtcvs.2010.10.014
  2. Song TK, Donayre CE, Walot I, et al. Endograft exclusion of acute and chronic descending thoracic aortic dissections. J Vasc Surg 2006;43:247-58. https://doi.org/10.1016/j.jvs.2005.10.065
  3. Greenberg RK, O'Neill S, Walker E, et al. Endovascular repair of thoracic aortic lesions with the Zenith TX1 and TX2 thoracic grafts: intermediate-term results. J Vasc Surg 2005;41:589-96. https://doi.org/10.1016/j.jvs.2005.01.043
  4. Drews JD, Patel HJ, Williams DM, Dasika NL, Deeb GM. The impact of acute renal failure on early and late outcomes after thoracic aortic endovascular repair. Ann Thorac Surg 2014;97:2027-33. https://doi.org/10.1016/j.athoracsur.2014.02.045
  5. Zhu JC, Chen SL, Jin GZ, et al. Acute renal injury after thoracic endovascular aortic repair of Stanford type B aortic dissection: incidence, risk factors, and prognosis. J Formos Med Assoc 2014;113:612-9. https://doi.org/10.1016/j.jfma.2014.01.017
  6. Martin MC, Giles KA, Pomposelli FB, Hamdan AD, Wyers MC, Schermerhorn ML. National outcomes after open repair of abdominal aortic aneurysms with visceral or renal bypass. Ann Vasc Surg 2010;24:106-12. https://doi.org/10.1016/j.avsg.2009.09.008
  7. Ellenberger C, Schweizer A, Diaper J, et al. Incidence, risk factors and prognosis of changes in serum creatinine early after aortic abdominal surgery. Intensive Care Med 2006;32:1808-16. https://doi.org/10.1007/s00134-006-0308-1
  8. Khoynezhad A, Donayre CE, Smith J, Kopchok GE, Walot I, White RA. Risk factors for early and late mortality after thoracic endovascular aortic repair. J Thorac Cardiovasc Surg 2008;135:1103-9. https://doi.org/10.1016/j.jtcvs.2008.02.001
  9. Bavaria JE, Appoo JJ, Makaroun MS, et al. Endovascular stent grafting versus open surgical repair of descending thoracic aortic aneurysms in low-risk patients: a multicenter comparative trial. J Thorac Cardiovasc Surg 2007;133:369-77. https://doi.org/10.1016/j.jtcvs.2006.07.040
  10. Patel HJ, Williams DM, Upchurch GR Jr, et al. Long-term results from a 12-year experience with endovascular therapy for thoracic aortic disease. Ann Thorac Surg 2006;82:2147-53. https://doi.org/10.1016/j.athoracsur.2006.06.046
  11. Patel HJ, Sood V, Williams DM, Dasika NL, Diener AC, Deeb GM. Late outcomes with repair of penetrating thoracic aortic ulcers: the merits of an endovascular approach. Ann Thorac Surg 2012;94:516-22. https://doi.org/10.1016/j.athoracsur.2012.03.074
  12. Barbash IM, Ben-Dor I, Dvir D, et al. Incidence and predictors of acute kidney injury after transcatheter aortic valve replacement. Am Heart J 2012;163:1031-6. https://doi.org/10.1016/j.ahj.2012.01.009
  13. Piffaretti G, Mariscalco G, Bonardelli S, et al. Predictors and outcomes of acute kidney injury after thoracic aortic endograft repair. J Vasc Surg 2012;56:1527-34. https://doi.org/10.1016/j.jvs.2012.05.106
  14. Bellomo R, Kellum JA, Ronco C. Defining and classifying acute renal failure: from advocacy to consensus and validation of the RIFLE criteria. Intensive Care Med 2007;33:409-13. https://doi.org/10.1007/s00134-006-0478-x
  15. Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604-12. https://doi.org/10.7326/0003-4819-150-9-200905050-00006
  16. Mariscalco G, Lorusso R, Dominici C, Renzulli A, Sala A. Acute kidney injury: a relevant complication after cardiac surgery. Ann Thorac Surg 2011;92:1539-47. https://doi.org/10.1016/j.athoracsur.2011.04.123
  17. Ma S, Zhao H, Ji X, Luo Y. Peripheral to central: organ interactions in stroke pathophysiology. Exp Neurol 2015;272:41-9. https://doi.org/10.1016/j.expneurol.2015.05.014
  18. Ninomiya T. Risk of stroke in kidney disease. Contrib Nephrol 2013;179:58-66.
  19. Mogi M, Horiuchi M. Clinical Interaction between Brain and Kidney in Small Vessel Disease. Cardiol Res Pract 2011;2011:306189.
  20. Bobadilla JL, Wynn M, Tefera G, Acher CW. Low incidence of paraplegia after thoracic endovascular aneurysm repair with proactive spinal cord protective protocols. J Vasc Surg 2013;57:1537-42. https://doi.org/10.1016/j.jvs.2012.12.032
  21. Rizvi AZ, Sullivan TM. Incidence, prevention, and management in spinal cord protection during TEVAR. J Vasc Surg 2010;52(4 Suppl):86S-90S. https://doi.org/10.1016/j.jvs.2010.06.148
  22. Drinkwater SL, Goebells A, Haydar A, et al. The incidence of spinal cord ischaemia following thoracic and thoracoabdominal aortic endovascular intervention. Eur J Vasc Endovasc Surg 2010;40:729-35. https://doi.org/10.1016/j.ejvs.2010.08.013
  23. Nuis RJ, Rodes-Cabau J, Sinning JM, et al. Blood transfusion and the risk of acute kidney injury after transcatheter aortic valve implantation. Circ Cardiovasc Interv 2012;5:680-8. https://doi.org/10.1161/CIRCINTERVENTIONS.112.971291
  24. Azzalini L, Spagnoli V, Ly HQ. Contrast-induced nephropathy: from pathophysiology to preventive strategies. Can J Cardiol 2015 May 23 [Epub]. http://dx.doi.org/10.1016/j.cjca.2015.05.013.