Thrombotic microangiopathy following aortic surgery with hypothermic circulatory arrest: a single-centre experience of an underestimated cause of acute renal failure
Autor: | Maximilian Pichlmaier, Ulf Schönermarck, Melissa Grigorescu-Vlass, Christian Hagl, Dietmar Wassilowsky, Michael Fischereder, Sven Peterss, D Joskowiak, Christine E. Kamla |
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Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Thrombotic microangiopathy medicine.medical_treatment Aorta Thoracic law.invention Postoperative Complications Aortic valve replacement Interquartile range law Risk Factors Internal medicine Vascular medicine Cardiopulmonary bypass Humans Dialysis Retrospective Studies Aortic Aneurysm Thoracic business.industry Thrombotic Microangiopathies Acute kidney injury Retrospective cohort study Odds ratio Acute Kidney Injury medicine.disease Circulatory Arrest Deep Hypothermia Induced Treatment Outcome Cardiology Surgery Female Cardiology and Cardiovascular Medicine business |
Zdroj: | Interact Cardiovasc Thorac Surg |
Popis: | OBJECTIVES Acute kidney injury (AKI) following surgery involving the heart-lung-machine is associated with high mortality and morbidity. In addition to the known mechanisms, thrombotic microangiopathy (TMA) triggered by the dysregulation of complement activation was recently described as another pathophysiological pathway for AKI following aortic surgery. The aim of this retrospective study was to analyse incidence, predictors and outcome in these patients. METHODS Between January 2018 and September 2019, consecutive patients undergoing aortic surgery requiring hypothermic circulatory arrest were retrospectively reviewed. If suspected, diagnostic algorithm was initiated to identify a TMA and its risk factors, and postoperative outcome parameters were comparably investigated. RESULTS The incidence of TMA in the analysed cohort (n = 247) was 4.5%. Multivariable logistic regression indicated female gender {odds ratio (OR) 4.905 [95% confidence interval (CI) 1.234–19.495], P = 0.024} and aortic valve replacement [OR 8.886 (95% CI 1.030–76.660), P = 0.047] as independent predictors of TMA, while cardiopulmonary bypass, X-clamp and hypothermic circulatory arrest times showed no statistically significance. TMA resulted in postoperative AKI (82%), neurological disorders (73%) and thrombocytopaenia [31 (interquartile range 25–42) G/l], corresponding to the diagnostic criteria. Operative mortality and morbidity were equal to patients without postoperative TMA, despite a higher incidence of re-exploration for bleeding (27 vs 6%; P = 0.027). After 6 months, survival, laboratory parameters and need for dialysis were comparable between the groups. CONCLUSIONS TMA is a potential differential diagnosis for the cause of AKI following aortic surgery regardless of the hypothermic circulatory arrest time. Timely diagnosis and appropriate treatment resulted in a comparable outcome concerning mortality and renal function. |
Databáze: | OpenAIRE |
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