Hematocrit and Renal Failure in Aortic Arch Surgery: A Society of Thoracic Surgeons Database Study.

Autor:	Brownlee SA; Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts., Hage A; Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Division of Cardiac Surgery, Western University, London, Ontario, Canada., Singh R; Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts., Sundt TM 3rd; Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts., Wasfy JH; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts., Shahian DM; Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts., Melnitchouk S; Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts., Bloom JP; Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts., Osho AA; Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts., Jassar AS; Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: ajassar@mgh.harvard.edu.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2024 Nov; Vol. 118 (5), pp. 1021-1027. Date of Electronic Publication: 2024 Aug 06.
DOI:	10.1016/j.athoracsur.2024.07.025
Abstrakt:	Background: This study examined the association between cardiopulmonary bypass (CPB) hematocrit and postoperative acute renal failure (ARF) in patients undergoing aortic arch surgery with hypothermic circulatory arrest. Methods: The Society of Thoracic Surgeons Adult Cardiac Surgery Database was queried from 2011 to 2019 for patients undergoing aortic arch surgery with hypothermic circulatory arrest. A multivariable logistic regression model estimated the adjusted odds of postoperative ARF on the basis of CPB hematocrit. Effects were stratified by preoperative kidney function and the duration of hypothermic circulatory arrest by using interaction terms. The study also investigated the association between postoperative ARF and major postoperative outcomes by using multivariable regression models. Results: On adjusted analysis, higher CPB hematocrit (>20%-25%, >25%-30%, >30%) was associated with lower odds of ARF as compared with lower CPB hematocrit (≤20%) (>20-25%, aOR, 0.78; 95% CI, 0.65-0.93; P = .006; >25%-30%, aOR, 0.65; 95% CI, 0.50-0.84; P = .0007; >30%, aOR, 0.45; 95% CI, 0.28-0.72; P = .0008). The predicted probability of postoperative ARF by CPB hematocrit was higher in patients with lower preoperative renal function (estimated glomerular filtration rate, <60 mL/min/1.73 m 2 ) (interaction P = .03). The association between hematocrit and postoperative ARF was not significantly modified by hypothermic circulatory arrest time (interaction P = .74). All postoperative outcomes were significantly worse in patients with postoperative ARF (all P < .0001). Conclusions: Among patients undergoing aortic arch surgery, a higher CPB hematocrit level is associated with reduced likelihood of postoperative ARF. Preoperative renal function, but not hypothermic circulatory arrest duration, significantly modified this association. The maintenance of higher CPB hematocrit may reduce the incidence of postoperative ARF, especially for patients with poor preoperative renal function. Competing Interests: Disclosures The authors have no conflicts of interest to disclose. (Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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