• Acute kidney injury
• acute kidney disease
• intraoperative hypotension
• type A aortic dissection
• venous congestion

• Humans
• Male
• Aortic Dissection/surgery
• Retrospective Studies
• Female
• Acute Kidney Injury/etiology
• Acute Kidney Injury/epidemiology
• Acute Kidney Injury/diagnosis
• Acute Kidney Injury/physiopathology
• Middle Aged
• Postoperative Complications/etiology
• Postoperative Complications/epidemiology
• Postoperative Complications/diagnosis
• Hemodynamics
• Aged
• Central Venous Pressure
• Risk Factors
• Adult
• Hypotension/etiology
• Hypotension/epidemiology

Rhabdomyolysis (RML) as an etiological factor causing acute kidney injury (AKI) is sparsely reported in the literature.

To study the incidence of RML after surgical repair of an ascending aortic dissection (AAD) and to correlate with the outcome, especially regarding renal function. To pinpoint the perioperative risk factors associated with the development of RML and adverse renal outcomes after aortic dissection repair.

Retrospective single-center cohort study conducted in a tertiary cardiac center. We included all patients who underwent AAD repair from 2011-2017. Post-operative RML workup is part of the institutional protocol; studied patients were divided into two groups: Group 1 with RML (creatine kinase above cut-off levels 2500 U/L) and Group 2 without RML. The potential determinants of RML and impact on patient outcome, especially postoperative renal function, were studied. Other outcome parameters studied were markers of cardiac injury, length of ventilation, length of stay in the intensive care unit), and length of hospitalization.

Out of 33 patients studied, 21 patients (64%) developed RML (Group RML), and 12 did not (Group non-RML). Demographic and intraoperative factors, notably body mass index, duration of surgery, and cardiopulmonary bypass, had no significant impact on the incidence of RML. Preoperative visceral/peripheral malperfusion, though not statistically significant, was higher in the RML group. A significantly higher incidence of renal complications, including de novo postoperative dialysis, was noticed in the RML group. Other morbidity parameters were also higher in the RML group. There was a significantly higher incidence of AKI in the RML group (90%) than in the non-RML group (25%). All four patients who required de novo dialysis belonged to the RML group. The peak troponin levels were significantly higher in the RML group.

In this study, we noticed a high incidence of RML after aortic dissection surgery, coupled with an adverse renal outcome and the need for post-operative dialysis. Prompt recognition and management of RML might improve the renal outcome. Further large-scale prospective trials are warranted to investigate the predisposing factors and influence of RML on major morbidity and mortality outcomes.

• Rhabdomyolysis
• Ascending aortic dissection surgery
• Acute kidney injury
• Postoperative renal outcome
• Open heart surgery
• Type A aortic dissection

• acute kidney injury
• acute type A aortic dissection
• lactate
• mortality
• total arch replacement

• R01 HL128831 NHLBI NIH HHS

• acute kidney injury
• aortic dissection
• cardiology
• meta-analysis
• mortality
• prevention

• Cardiovascular medicine
• Public health

• acute kidney injury
• cardiac surgery
• nomogram
• prediction model
• risk factors

• the Chongqing Natural Science Foundation Project
• Clinical technology Innovation Cultivation Project of Army Medical University
• Major project of Logistics research Program of Army Medical University
• Precision kidney Therapy Research Program of Army Medical University

• Acute kidney injury
• Artificial neural network
• Machine learning
• Prediction
• Total aortic arch replacement

• health sciences
• medicine
• pathophysiology

• Aortic dissection
• Creatinine
• Dialysis
• Renal dysfunction

• Male
• Female
• Humans
• Patient Discharge
• Retrospective Studies
• Aortic Dissection/surgery
• Renal Dialysis
• Risk Factors
• Acute Kidney Injury/etiology
• Acute Kidney Injury/therapy
• Treatment Outcome
• Blood Vessel Prosthesis Implantation

• aortic dissection
• complications
• management
• outcomes
• type A

• Aortic dissection
• Delirium
• Meta-analysis
• Risk factor

• Humans
• Aortic Dissection/surgery
• Emergence Delirium
• Renal Insufficiency
• Risk Factors

• 2021-LCYJ-PY-18 Clinical Trials from the Affiliated Drum Tower Hospital, Medical School of Nanjing University
• NDYG2021003 Project of Modern Hospital Management and Development Institute, Nanjing University and Aid project of Nanjing Drum Tower Hospital Health, Education & Research Foundation
• Project of Modern Hospital Management and Development Institute, Nanjing University and Aid project of Nanjing Drum Tower Hospital Health, Education & Research Foundation

• Acute kidney injury
• Chitinase 3-like 1
• Nomogram
• Pentraxin 3
• S100A8/A9
• Type A aortic dissection

• Humans
• Lipocalin-2
• Prospective Studies
• Incidence
• Proteomics
• Biomarkers
• Acute Kidney Injury/diagnosis
• Acute Kidney Injury/epidemiology
• Acute Kidney Injury/etiology
• Predictive Value of Tests

• CZXM2022101 Characteristic Project of Combined TCM and West Medicine Nanjing Drum Tower Hospital
• ZDXK202229 Jiangsu Provincial Medical Key Discipline
• Jiangsu Province Capability Improvement Project through Science, Technology and Education

• acute kidney injury
• arch surgery
• circulatory arrest

• Adult
• Humans
• Retrospective Studies
• Aorta, Thoracic/surgery
• Risk Factors
• Treatment Outcome
• Acute Kidney Injury/diagnosis
• Acute Kidney Injury/epidemiology
• Acute Kidney Injury/etiology
• Heart Arrest
• Ischemia
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology

• acute kidney injury
• aortic dissection
• lactate
• minimally invasive approach
• total arch replacement

• Stanford type A acute aortic dissection
• aortic dissection
• gender gap
• in-hospital mortality
• risk factors

• Acute kidney injury
• Body mass index
• Cardiac surgery
• Cardiopulmonary bypass
• Clinical outcome
• Obesity paradox
• Robotic surgery

• 2018ZDXM003 Science-Health Joint Medical Scientific Research Project of Chongqing
• 2018ZDXM003 Science-Health Joint Medical Scientific Research Project of Chongqing
• 2018ZDXM003 Science-Health Joint Medical Scientific Research Project of Chongqing
• 2018ZDXM003 Science-Health Joint Medical Scientific Research Project of Chongqing
• 2018ZDXM003 Science-Health Joint Medical Scientific Research Project of Chongqing
• 2018ZDXM003 Science-Health Joint Medical Scientific Research Project of Chongqing
• 2018ZDXM003 Science-Health Joint Medical Scientific Research Project of Chongqing

• acute type A aortic dissection
• in-hospital mortality
• risk factors, surgical repair
• total arch procedure

• Acute kidney disease
• Acute kidney injury
• Outcomes
• Risk factors
• acute type A aortic dissection

• Acute Kidney Injury
• Aortic Repair
• Malperfusion
• Serum Myoglobin
• Stanford Type A Aortic Dissection

• acute kidney injury
• acute type A aortic dissection
• continuous renal replacement therapy (CRRT)
• risk factor
• thromboelastography (TEG)

• Acute kidney injury
• Aortic dissection
• Renal failure

• Humans
• Retrospective Studies
• Risk Factors
• Acute Kidney Injury/diagnosis
• Acute Kidney Injury/epidemiology
• Acute Kidney Injury/etiology
• Kidney
• Aortic Dissection/complications
• Aortic Dissection/surgery
• Incidence

• FS/17/24/32596 British Heart Foundation

• Acute kidney injury
• Cystatin C
• Total aortic arch replacement
• Type A aortic dissection
• Urine N-acetyl-β-d-glucosaminidase

• Humans
• Acetylglucosaminidase
• Cystatin C
• Aorta, Thoracic
• Acute Kidney Injury/diagnosis
• Acute Kidney Injury/etiology
• Biomarkers
• ROC Curve

• acute kidney injury (aki)
• acute type a aortic dissection (ataad)
• body mass index (bmi)
• continuous renal replacement therapy (crrt)
• histamine

• Humans
• Retrospective Studies
• Histamine
• Biomarkers
• Risk Factors
• Acute Kidney Injury/epidemiology
• Acute Kidney Injury/etiology
• Acute Kidney Injury/therapy
• Postoperative Complications/epidemiology

Background: Risk factors for acute kidney injury (AKI) after Stanford type A aortic dissection (TAAD) repair are inconsistent in different studies. This meta-analysis systematically analyzed the risk factors so as to early identify the therapeutic targets for preventing AKI.

Methods: Studies exploring risk factors for AKI after TAAD repair were searched from four databases from inception to June 2022. The synthesized incidence and risk factors of AKI and its impact on mortality were calculated.

Results: Twenty studies comprising 8223 patients were included. The synthesized incidence of postoperative AKI was 50.7%. Risk factors for AKI included cardiopulmonary bypass (CPB) time >180 min [odds ratio (OR), 4.89, 95% confidence interval (CI), 2.06–11.61, I² = 0%], prolonged operative time (>7 h) (OR, 2.73, 95% CI, 1.95–3.82, I² = 0), advanced age (per 10 years) (OR, 1.34, 95% CI, 1.21–1.49, I² = 0], increased packed red blood cells (pRBCs) transfusion perioperatively (OR, 1.09, 95% CI, 1.07–1.11, I² = 42%), elevated body mass index (per 5 kg/m²) (OR, 1.23, 95% CI, 1.18–1.28, I² = 42%) and preoperative kidney injury (OR, 3.61, 95% CI, 2.48–5.28, I² = 45%). All results were meta-analyzed using fixed-effects model finally (p < 0.01). The in-hospital or 30-day mortality was higher in patients with postoperative AKI than in that without AKI [risk ratio (RR), 3.12, 95% CI, 2.54–3.85, p < 0.01].

Conclusions: AKI after TAAD repair increased the in-hospital or 30-day mortality. Reducing CPB time and pRBCs transfusion, especially in elderly or heavier weight patients, or patients with preoperative kidney injury were important to prevent AKI after TAAD repair surgery.

• Type A aortic dissection
• acute kidney injury
• risk factors

This study aimed to develop a nomogram to predict reduced cardiac function for acute kidney injury (AKI) patients who received continuous renal replacement therapy (CRRT) after acute type A aortic dissection (ATAAD) surgery.

This study was a retrospective analysis. ATAAD patients with preoperative normal ejection fraction (EF) and postoperative AKI with CRRT admitted between January 2014 and November 2021 were included. The reduced cardiac function was defined as EF <50%. The data were analyzed by the univariate and multivariate logistic regression analyses. A diagnostic model was established by a nomogram, and its discriminative performance was validated by the received operating characteristic (ROC) curve and concordance (C) statistic. The calibration of the diagnostic model was tested by calibration curves and the HosmerLemeshow test. The clinical utility was evaluated by the decision curve analysis (DCA).

In total, 208 patients were eligible for analysis, of which 98 patients with reduced cardiac function. The logistic regression analyses showed age ≥60 years old, history of coronary atherosclerotic disease, preoperative pericardial tamponade, and cardiopulmonary bypass time were risk factors for reduced cardiac function, which were further employed in the nomogram. As results, nomogram revealed a high predictive power (C statistic = 0.723, 0.654–0.792; the bootstrap-corrected concordance C statistic = 0.711, the area under the ROC curve = 0.723). The calibration curves showed good consistency between the predicted and the actual probabilities (calibration curve: Brier points = 0.208, Emax = 0.103, Eavg = 0.021; Hosmer-Lemeshow test, P = 0.476). DCA showed that the nomogram could augment net benefits and exhibited a wide range of threshold probabilities in the prediction of EF reduction.

This nomogram is an effective diagnostic model for predicting the reduced cardiac function in postoperative ATAAD patients with AKI undergoing CRRT and can be used to protect postoperative renal functions and facilitate patient-specific care after ATAAD surgery.

• acute aortic dissection
• acute renal failure
• aorta
• hemiarch replacement
• perioperative management
• survival
• total arch replacement

This study aimed to construct a model to predict the risk of in-hospital death in patients with acute renal injury (AKI) receiving continuous renal replacement therapy (CRRT) after acute type A aortic dissection (ATAAD) surgery.

We reviewed the data of patients with AKI undergoing CRRT after ATAAD surgery. The patients were divided into survival and nonsurvival groups based on their vital status at hospital discharge. The data were analyzed using univariate and multivariate logistic regression analyses. Establish a risk prediction model using a nomogram and its discriminative ability was validated using C statistic and the receiver operating characteristic (ROC) curve. Its calibration ability was tested using a calibration curve, 10-fold cross-validation and Hosmer–Lemeshow test.

Among 175 patients, in-hospital death occurred in 61 (34.9%) patients. The following variables were incorporated in predicting in-hospital death: age > 65 years, lactic acid 12 h after CRRT, liver dysfunction, and permanent neurological dysfunction. The risk model revealed good discrimination (C statistic = 0.868, 95% CI: 0.806–0.930; a bootstrap-corrected C statistic of 0.859, the area under the ROC = 0.868). The calibration curve showed good consistency between predicted and actual probabilities (via 1,000 bootstrap samples, mean absolute error = 2.2%; Hosmer–Lemeshow test, P = 0.846). The 10-fold cross validation of the nomogram showed that the average misdiagnosis rate was 16.64%.

The proposed model could be used to predict the probability of in-hospital death in patients undergoing CRRT for AKI after ATAAD surgery. It had the potential to assist doctors to identify the gravity of the situation and make the targeted therapeutic measures.

• Beijing Municipal Science and Technology Commission

Postoperative acute kidney injury (AKI) in acute DeBakey type I aortic dissection (ADIAD) is common but has unclear pathogeneses and limited treatments. Receptor-interacting protein kinase 3 (RIP3), a mediator of necroptosis, is associated with human sepsis-induced and posttraumatic AKI, but its role in human postoperative AKI in ADIAD remains unclear. We assumed that RIP3 levels is associated with postoperative AKI in ADIAD.

Plasma samples and the clinical data of continuous patients with ADIAD were collected prospectively. The patients were divided into three groups according to AKI stage postoperatively. The plasma RIP3 levels were compared among the groups, and the relationship between RIP3 and serum creatinine (sCr), inflammatory cytokines as well as clinical results were analyzed.

Eighty patients were enrolled. The postoperative and elevated RIP3 levels among the three groups were significantly different (P < 0.0001), both with a positive trend across the AKI stage (P for trend < 0.001), and they were also independent risk factors for postoperative AKI in ADIAD (OR = 1.018 and 1.026, P < 0.05). The postoperative RIP3 levels were positively correlated with the aortic crossclamp time (R = 0.253, P < 0.05); the peak values of sCr, procalcitonin, interleukin-6 and lactate postoperatively; the mechanical ventilation time; and the ICU stay time (R = 0.66, 0.369, 0.409, 0.397, 0.474 and 0.435, respectively; all P < 0.001). Plasma RIP3 level and sCr were comparable in diagnosing postoperative AKI in ADIAD (P = 0.898), and higher postoperative RIP3 level was associated with lower survival rate.

The plasma RIP3 levels are associated with postoperative AKI, inflammatory response and clinical outcomes in ADIAD.

The online version contains supplementary material available at 10.1186/s13019-022-01783-0.

• Acute DeBakey type I aortic dissection
• Acute kidney injury
• Necroptosis
• Receptor-interacting protein kinase 3

• Acute kidney injury
• Outcomes
• Type A aortic dissection

• CRRT
• acute kidney injury
• acute type A aortic dissection
• continuous renal replacement therapy
• risk factors
• surgery

Acute kidney injury (AKI) is one of the most common and serious complications in patients with type B aortic dissection (TBAD). This study aimed at investigating the incidence and risk factors of in-hospital AKI in TBAD patients involving the renal artery who underwent thoracic endovascular aortic repair (TEVAR) only.

A total of 256 patients who were diagnosed as TBAD combined with renal artery involvement were included in this retrospective study. All patients were divided into the AKI group and the non-AKI group according to the KDIGO criteria. The risk factors for AKI were identified using a multivariate logistic regression model.

A total of 256 patients were included in this study, and the incidence of AKI was 18% (46/256). Patients in the AKI group were more likely to have a higher proportion of the youth, a higher level of body mass index, and a shorter time from onset to admission. Multivariate logistic regression analysis revealed that the youth (age ≤40 years) (OR: 2.853, 95%CI: 1.061–7.668, p = .038) were prone to AKI, and lower estimated glomerular filtration rate (eGFR) (OR: 1.526, per 15-ml/min/1.73 m² decrease, 95%CI: 1.114–2.092; p = .009), higher diastolic blood pressure (DBP) (OR: 1.418, per 10-mmHg increase; 95%CI: 1.070–1.879; p = .015), and fasting blood glucose (FBG) ≥7 mmol/L on admission (OR: 2.592; 95%CI: 1.299–5.174; p = .007) were independent risk factors for AKI.

Higher incidence of AKI had been perceived in this study, most of them were young and middle-aged patients. Renopreventive measures should be considered in those high-risk patients with younger age, lower eGFR, higher DBP, and higher FBG on admission.

• Acute kidney injury
• TEVAR
• risk factors
• type B aortic dissection

Cannulation strategy in surgery for acute type A aortic dissection (ATAAD) remains controversial. We aimed to retrospectively analyze the safety and efficacy of double arterial cannulation (DAC) compared with right axillary cannulation (RAC) for ATAAD.

From January 2016 to December 2018, 431 ATAAD patients were enrolled in the study. Patients were divided into DAC group (n = 341) and RAC group (n = 90). Propensity score matching analysis was performed to compare the early and mid-term outcomes between these two groups. To confirm the organ protection effect by DAC, intraoperative blood gas results and cardiopulmonary bypass parameters were compared between the two groups.

Demographics and preoperative comorbidities were comparable between two groups, while patients in DAC group were younger than RAC group (51.55 ± 13.21 vs. 56.07 ± 12.16 years, P < 0.001). DAC had a higher incidence of limb malperfusion (18.2% vs. 10.0%, P = 0.063) and lower incidence of coronary malperfusion (5.3% vs. 12.2%, P = 0.019). No significant difference in cardiopulmonary bypass and cross-clamp time was found between the two groups. The in-hospital mortality was 13.5% (58/431), while there was no difference between the two groups (13.5% vs. 13.3%; P = 0.969). Patients who underwent DAC had higher incidence of postoperative stroke (5.9% vs. 0%, P = 0.019) and lower incidence of postoperative acute kidney injury (AKI) (24.7% vs. 40.3%; P = 0.015). During a mean follow-up period of 31.8 (interquartile range, 25–45) months, the overall survival was 81.5% for DAC group and 78.0% for RAC group (P = 0.560). Intraoperative blood gas results and cardiopulmonary bypass parameters showed that DAC group had more intraoperative urine output volume than RAC group (P = 0.05), and the time of cooling (P = 0.04) and rewarming (P = 0.04) were shorter in DAC group.

DAC will not increase the surgical risks compared to RAC, but could reduce the incidence of postoperative AKI which may be benefit for renal protection.

The online version contains supplementary material available at 10.1186/s13019-021-01714-5.

• Aortic dissection
• Cannulation
• Malperfusion

This study aimed to identify risk factors for 30-day mortality in patients who received DeBakey type I aortic dissection (AD) repair surgery.

A total of 830 consecutive patients who received acute DeBakey type I AD surgery between 2014 and 2019 were included in the study. The associations between 30-day mortality and perioperative parameters were examined in order to identify risk factors.

Our data suggested that the overall 30-day mortality rate of all enrolled patients was 11.7%. Unsurprisingly, non-survivors were older and more frequently accompanied with histories of cardiovascular diseases. For intraoperative parameters, the prevalence of coronary artery bypass grafting and cardiopulmonary bypass times were increased in non-survivors. In addition, acute kidney injury (AKI), dialysis, stroke, and deep sternal wound infection were more commonly seen among non-survivors. The multivariate logistic regression analysis suggested that cardiovascular disease history, preoperative D-dimer level, drainage volume 24 h after surgery, and postoperative AKI were independent risk factors for 30-day mortality after DeBakey type I aortic dissection repair surgery.

Our study demonstrated that cardiovascular disease history, preoperative D-dimer level, drainage volume 24 h after surgery as well as postoperative AKI were risk factors for 30-day mortality after DeBakey type I aortic dissection repair surgery.

• 30-day mortality
• Aortic dissection
• Risk factors

Background: The post-operative acute kidney injury (AKI) represents a common complication in the Acute Debakey Type I Aortic Dissection (ADTIAD) and predicts a poorer prognosis. The clinical evidence is scarce supporting the predictive value of the pre-operative lymphocyte-to-monocyte ratio (LMR) in post-operative AKI in ADTIAD.

Methods: In this retrospective cohort study, 190 consecutive patients with ADTIAD enrolled for surgical treatment between January 1, 2013, and December 31, 2018. The diagnosis of AKI followed the Kidney Disease: Improving Global Outcomes guidelines (KDIGO). Pre-operative LMR and other possible risk factors were analyzed for their prognostic value in the post-operative AKI in ADTIAD.

Results: The subjects were assigned to the low-LMR and high-LMR groups according to the median value of pre-operative LMR. For post-operative AKI, the incidence and the severity in the low-LMR group were statistically different from that of the high-LMR group. Besides, the lower LMR was statistically associated with the more extended ICU stay and intubation time and higher incidences of ischemic stroke and in-hospital mortality. Additionally, in the multivariable analysis, the pre-operative LMR was an independent predictor for post-operative AKI in ADTIAD. A predictive model for post-operative AKI in ADTIAD was established incorporating LMR.

Conclusions: LMR is an independent prognostic indicator incorporated into the predictive model with other risk factors to predict the post-operative AKI in ADTIAD.

• acute Debakey type I aortic dissection
• acute kidney injury
• lymphocyte-to-monocyte ratio
• predictive model
• risk factor

• Acute Stanford Type A aortic dissection
• Acute kidney injury
• Fresh frozen plasma
• Packed red blood cells
• Platelet concentrates
• Total aortic arch replacement

• aortic dissection
• multi-slice computed tomography
• radiomics
• receiver operating characteristic curve

• Acute Disease
• Adult
• Aged
• Aortic Dissection/diagnostic imaging
• Aorta/pathology
• Aortic Aneurysm/complications
• Computed Tomography Angiography/methods
• Female
• Humans
• Image Enhancement/instrumentation
• Image Processing, Computer-Assisted/methods
• Male
• Middle Aged
• ROC Curve
• Retrospective Studies
• Sensitivity and Specificity
• Tomography, X-Ray Computed/methods