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      Preoperative renal malperfusion is an independent predictor for acute kidney injury and operative death but not associated with late mortality after surgery for acute type A aortic dissection

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          Abstract

          OBJECTIVES

          This study was aimed to investigate the impact of preoperative renal malperfusion on early and late outcomes after surgery for acute type A aortic dissection (AAAD).

          METHODS

          Of 915 patients who underwent surgery for AAAD between September 2004 and September 2017, we enrolled 534 patients whose preoperative enhanced computed tomography images were retrospectively available in this study. Exclusion criteria were single kidney (n = 3) and dialysis-dependent preoperatively (n = 12). We compared early and late outcomes between patients who had preoperative renal malperfusion (n = 64) and those who did not have renal malperfusion (n = 470).

          RESULTS

          The incidence of postoperative acute kidney injury, defined using the Kidney Disease: Improving Global Outcomes criteria, was higher in the renal malperfusion group than in the no renal malperfusion group (76.6% vs 39.4%; P < 0.001). Similarly, operative death was more frequently seen in the renal malperfusion group (12.5% vs 3.8%; P = 0.003). Multivariate analyses showed that renal malperfusion was the independent predictor for postoperative acute kidney injury [odds ratio 4.32, 95% confidence interval (CI) 2.25–8.67; P < 0.001] and operative death (odds ratio 3.08, 95% CI 1.02–8.86; P = 0.046). The median follow-up period in the hospital survivors was 3.3 years (interquartile range 2.1–6.7 years). The cumulative survival rate at 8 years was similar between the groups (74.6% in the renal malperfusion group and 76.0% in the no renal malperfusion group; P = 0.349).

          CONCLUSIONS

          Preoperative renal malperfusion is an independent predictor for postoperative acute kidney injury and operative death but not associated with late mortality after surgery for acute type A aortic dissection.

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          Most cited references22

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          Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1)

          Acute kidney injury (AKI) is a common and serious problem affecting millions and causing death and disability for many. In 2012, Kidney Disease: Improving Global Outcomes completed the first ever, international, multidisciplinary, clinical practice guideline for AKI. The guideline is based on evidence review and appraisal, and covers AKI definition, risk assessment, evaluation, prevention, and treatment. In this review we summarize key aspects of the guideline including definition and staging of AKI, as well as evaluation and nondialytic management. Contrast-induced AKI and management of renal replacement therapy will be addressed in a separate review. Treatment recommendations are based on systematic reviews of relevant trials. Appraisal of the quality of the evidence and the strength of recommendations followed the Grading of Recommendations Assessment, Development and Evaluation approach. Limitations of the evidence are discussed and a detailed rationale for each recommendation is provided.
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            Insights From the International Registry of Acute Aortic Dissection: A 20-Year Experience of Collaborative Clinical Research.

            Acute aortic dissection (AAD) is a life-threatening condition associated with high morbidity and mortality rates, and it remains a challenge to diagnose and treat. The International Registry of Acute Aortic Dissection was established in 1996 with the mission to raise awareness of this condition and provide insights to guide diagnosis and treatment. Since then, >7300 cases have been included from >51 sites in 12 countries. Although presenting symptoms and physical findings have not changed significantly over this period, the use of computed tomography in the diagnosis has increased, and more patients are managed with interventional procedures: surgery in type A AAD and endovascular therapy in type B AAD; with these changes in care, there has been a significant decrease in overall in-hospital mortality in type A AAD but not in type B AAD. Herein, we summarized the key lessons learned from this international registry of patients with AAD over the past 20 years.
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              Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends From the International Registry of Acute Aortic Dissection.

              Diagnosis, treatment, and outcomes of acute aortic dissection (AAS) are changing.
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                Author and article information

                Journal
                European Journal of Cardio-Thoracic Surgery
                Oxford University Press (OUP)
                1010-7940
                1873-734X
                August 2020
                August 01 2020
                March 17 2020
                August 2020
                August 01 2020
                March 17 2020
                : 58
                : 2
                : 302-308
                Affiliations
                [1 ]Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
                [2 ]Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
                [3 ]Biostatistics and Bioinformatics Course, The University of Tokyo, Tokyo, Japan
                Article
                10.1093/ejcts/ezaa063
                32182351
                3e406603-4c3d-4ede-a6d7-f4be9935af5e
                © 2020

                https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model

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