Acute Kidney Injury After Pulmonary Thromboendarterectomy: Associated Factors and Impact.

BACKGROUND: Acute kidney injury (AKI) is a common complication after pulmonary thromboendarterectomy (PTE) that has been shown to be associated with worse outcomes. Our study assesses factors associated with the development of postoperative AKI after PTE and its impact on clinical outcomes. METHODS: We retrospectively analyzed 247 patients who underwent PTE at our institution between June 2009 and December 2020. Baseline characteristics, risk factors, and outcomes were compared between patients with and without postoperative AKI. The primary endpoint was development of postoperative AKI using the Kidney Disease Improving Global Outcomes definition, and secondary endpoints were length of hospital stay, hospital mortality, and 5-year mortality. RESULTS: The overall incidence of postoperative AKI in our study population was 49%. One hundred twenty-three patients (50.8%) did not develop AKI postoperatively, 87 patients (35.9%) developed stage 1 AKI postoperatively, 21 patients (8.7%) developed stage 2 AKI postoperatively, and 11 (4.5%) developed stage 3 AKI postoperatively. Patients who developed AKI postoperatively had longer hospital stays, higher in-hospital mortality rates, and higher 5-year mortality rates than patients who did not develop postoperative AKI. Higher body mass index, older age, low preoperative hemoglobin, low ejection fraction, and low creatinine were shown to be associated with postoperative AKI development. CONCLUSIONS: Patients who developed AKI after PTE had worse mortality and morbidity. Clinicians should have a lower threshold for suspecting AKI and consider implementing Kidney Disease Improving Global Outcomes-based AKI prevention bundles for patients with factors associated with development of AKI.

Common atrium and pulmonary vascular disease.

This report describes a case series of six patients with congenital common atrium who developed pulmonary vascular disease. Three developed early pulmonary vascular disease within their first year of life, while the others became symptomatic at ages 2, 5, and 17. Four of the six underwent surgical repair, and five of the six patients are being treated on targeted pulmonary hypertension therapy. Based on our observations, the clinical course of children with common atrium may differ from patients with a large atrial septal defect. Early monitoring and surgical correction, if necessary, may prevent the onset of severe pulmonary vascular disease.