Acute Kidney Injury: Lessons from Pericardiectomy

Authors

  • Jing-bin Huang, MD Department of Cardiothoracic Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan Road, Nanning, Guangxi, China
  • Zhao-ke Wen, MD Department of Cardiothoracic Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan Road, Nanning, Guangxi, China
  • Chang-chao Lu, MD Department of Cardiothoracic Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan Road, Nanning, Guangxi, China
  • Wei-jun Lu, MD Department of Cardiothoracic Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan Road, Nanning, Guangxi, Chin
  • Xian-ming Tang, MD Department of Cardiothoracic Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan Road, Nanning, Guangxi, China
  • Xiang-wei Li, MD Department of Cardiothoracic Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan Road, Nanning, Guangxi, China
  • Xin Deng, MD Department of Cardiothoracic Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan Road, Nanning, Guangxi, China

DOI:

https://doi.org/10.1532/hsf.3869

Keywords:

Acute kidney injury, risk factors, prevention, management, pericardiectomy

Abstract

Background: Acute kidney (renal) injury (AKI) is a severe and common complication that occurs in ~40% of patients undergoing cardiac surgery. AKI has been associated with increased mortality and worse prognosis. This prospective study was conducted to determine the risk factors for AKI after pericardiectomy and decrease the operative risk of mortality and morbidity.

Methods: This was a prospective, observational cohort study of patients with constrictive pericarditis undergoing pericardiectomy. All patients underwent pericardiectomy via median sternotomy. Serum creatinine was used as the diagnostic standard of AKI according to Kidney Disease
Improving Global Outcomes classification. All survivors were monitored to the end date of the study.

Results: Consecutive patients (N = 92) undergoing pericardiectomy were divided into 2 groups: with AKI (n = 25) and without AKI (n = 67). The incidence of postoperative AKI was 27.2% (25/92). Hemodialysis was required for 10 patients (40%), and there were 5 operative deaths. Mortality, intubation time, time in intensive care unit, fresh-frozen plasma, and packed red cells of the group with AKI were significantly higher than those of the group without AKI. Both univariate and multivariate analyses showed that statistically significant independent predictors of AKI include intubation time, chest drainage, fresh-frozen plasma, and packed red cells. The latest follow-up data showed that 85 survivors were New York Heart Association class I (97.7%) and 2 were
class II (2.3%).

Conclusions: AKI after pericardiectomy is a serious complication and contributes to significantly increased morbidity and mortality. Prevention of AKI development after cardiac surgery and optimization of pre-, peri-, and postoperative factors that can reduce AKI, therefore, contribute to a better postoperative outcome and leads to lower rates of AKI, morbidity, and mortality.

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Published

2021-07-27

How to Cite

Huang, J.- bin, Wen, Z.- ke ., Lu, C.- chao ., Lu, W.- jun ., Tang, X.- ming ., Li, X.- wei, & Deng, X. (2021). Acute Kidney Injury: Lessons from Pericardiectomy. The Heart Surgery Forum, 24(4), E656-E661. https://doi.org/10.1532/hsf.3869

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Section

Articles