AUTHOR=Lyu Ying , Liu Yu , Xiao Xiong , Yang Zhonglu , Ge Yuguang , Jiang Hui 

TITLE=High level of intraoperative lactate might predict acute kidney injury in aortic arch surgery via minimally invasive approach in patients with type A dissection

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1188393

DOI=10.3389/fcvm.2023.1188393

ISSN=2297-055X

ABSTRACT=Background: A high incidence of acute kidney injury (AKI) has been recorded in total arch replacement (TAR) combined with frozen elephant trunk (FET) implantation in patients with acute type A dissection (ATAAD) via median sternotomy approach with some risk factors. However, the independent risk factors for AKI via a minimally invasive approach have not yet been identified.
Methods: A total of 207 patients with ATAAD were enrolled from January 2018 and November 2019 and were divided into AKI and non-AKI groups. The current surgical strategy was TAR combined with FET via a single upper hemisternotomy approach, a minimally invasive method. An increase in the serum creatinine level to ≥ 2 times the baseline level 48 h post-surgery was defined as AKI. The morbidity of AKI was investigated with a multivariate analysis of its independent risk factors and a receiver operating characteristic curve anlysis.
Results: Postoperative AKI was observed in 39 (18.8%) patients, and the total hospital mortality was 8.7%. Univariate analysis found that preoperative creatinine (Cr), weight, circulatory arrest time ≥ 60 min, intraoperative Intraoperative highest Lactate (Lac), and intraoperative transfusion had significant differences between the two groups. However, multivariate stepwise logistic regression analysis identified intraoperative highest Lac and transfusion as independent risk factors for postoperative AKI and intraoperative highest Lac was identified as the most critical independent risk factor estimated by the partial chi-square statistic minus the predicted degrees of freedom with 4.3 μmol/L as the optimal cut-off point for prediction for AKI.
Conclusions: Intraoperative highest Lac level was the critical independent risk factors for postoperative AKI, which led to high hospital mortality. High level of intraoperative highest Lac (4.3 μmol/L ) might predict for postoperative AKI.