Incidence and outcome of rhabdomyolysis after type A Aortic
Dissection surgery -a retrospective analysis
Praveen C Sivadasan1 *
Email:
drpraveencs@gmail.com
Amr S Omar1.2,3Email:
a_s_omar@yahoo.com
Cornelia S Carr1Email: ccarr@hamad.qa
Abdul Rasheed A Pattath 1,3Email:
drrashmanson@gmail.com
Samy Hanoura1,3,4Email:
sehanoura73@yahoo.com
Suraj Sudarsanan1Email:
drsurajsudarsan@gmail.com
Hany Ragab1Email:
Hanyragab73@gmail.com
Hatem Sarhan1,5Email: HSarhan2@hamad.qa
Arunabha Karmakar1,5Email:
arunabha.karmakar@gmail.com
Rajvir Singh 5
- Department of Cardiothoracic Surgery/Cardiac Anaesthesia & ICU
Section, Heart Hospital, Hamad Medical Corporation, Doha, (PO Box:
3050), Qatar
- Department of Critical Care Medicine, Beni Suef University, Egypt
- Weill Cornell Medical College-Qatar, Doha, Qatar
- Department of Anesthesia, Al-Azhar University, Cairo, Egypt
- Department of Medical Education, Hamad Medical Corporation, Doha,
Qatar
- Department of Medical Research, Hamad Medical Corporation, Doha, Qatar
* Corresponding author. Department of Cardiothoracic Surgery/Cardiac
Anaesthesia & ICU Section, Heart Hospital, Hamad Medical Corporation,
Doha, (PO: 3050), Qatar
Email:
drpraveencs@gmail.comIncidence and outcome of rhabdomyolysis after type A aortic
dissection surgery. A single center retrospective analysisIntroduction
Despite ongoing research, the etiology of acute kidney injury (AKI)
remains incompletely understood; especially after aortic dissection
surgeries. The association of rhabdomyolysis (RML) and acute kidney
injury (AKI) with cardiac surgery has been evaluated and reported by us
in a recently concluded study1, but there is a lack of
robust data regarding the same in aortic dissection surgeries
specifically.
Rhabdomyolysis is a syndrome characterized by breakdown of skeletal
muscles and release of toxic intracellular contents into the systemic
circulation causing damage to renal tubules. RML may be caused by a
myriad of etiologies, predominantly by direct trauma to muscles as seen
in crush injuries, burns or prolonged muscle compression. It could also
be associated with congenital disorders of metabolism, certain drugs
like anesthetic agents, neuroleptic agents and statins, infections and
sustained muscle contraction (seizures and prolonged exercise for
example)2. The illness might vary in severity from
asymptomatic elevations in markers of muscle injury (namely Creatinine
Kinase (CK) and Myoglobin); to severe cases associated with extreme
enzyme elevation and renal shut down culminating in
dialysis3. Postoperative Rhabdomyolysis is being
increasingly recognized as a cause of renal failure. RML is a well-known
complication after bariatric, Urologic and orthopedic
surgery4. One retrospective review which analyzed
myoglobin as a marker of myocardial injury post-cardiac surgery reported
myoglobin to be superior to creatine kinase (CK) for prediction of
mortality and need for renal replacement therapy5. The
literature linking RML to cardiac surgery was largely confined to
isolated case reports6 until our
study1 was published. The aforementioned study in our
center, in which we noticed an unusually high incidence of RML among the
patients undergoing type A aortic dissection repair laid the foundation
for this broader retrospective analysis specifically looking for a link
between RML and aortic surgeries.
Acute kidney injury (AKI) complicates recovery from cardiac surgery in
up to 30 % of patients and places patients at a 5-fold increased risk
of death during hospitalization. Etiology is often multifactorial and
preventive strategies are limited. AKI that requires renal replacement
therapy occurs in 2–5 % of patients following cardiac surgery and is
associated with 50 % mortality7.
Aortic surgeries are specifically associated with a higher incidence of
renal complications than other types of cardiac surgery (with a reported
incidence of AKI ranging from 18% to 55%)8. A
significant number of patients with ascending aortic dissection (AAD)
have chronic renal impairment on presentation9. Renal
failure and dialysis after aortic dissection surgery is an independent
predictor of mortality as per the International Registry of Acute Aortic
Dissection. Perioperative predictors for postoperative AKI and renal
replacement therapy according to various studies were estimated
preoperative glomerular filtration rate, coronary ischemic time, renal
artery involvement in dissection, total arch replacement, preoperative
oliguria, longer cardiopulmonary bypass and hypothermic circulatory
arrest times, high body mass index, elevated C reactive protein,
perioperative sepsis and postoperative bleeding requiring a surgical
revision10-14. Till date, there are no published
studies linking rhabdomyolysis with aortic dissection except for a
single case report15. Myoglobin has reportedly been
linked to renal morbidity and mortality after thoracic and
thoraco-abdominal aortic surgeries16