HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John G.T. Augoustides Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Augoustides, J. G.T. Search for Related Content PubMed Articles by Augoustides, J. G.T. Related Collections Extracorporeal circulation Great vessels

J Thorac Cardiovasc Surg 2008;136:233
© 2008 The American Association for Thoracic Surgery

Letter to the Editor

RIFLE criteria in aortic arch surgery: The further role of surgical subgroup

Assistant Professor, Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104

To the Editor:

I read with great interest the recent article by Arnaoutakis and colleagues¹ detailing their application of the RIFLE (risk, injury, failure, loss, end stage) criteria in aortic arch surgery. Arnaoutakis and colleagues¹ clearly demonstrated a significant relationship between degree of renal injury and operative mortality. Their series of 267 patients, however, was heterogeneous with respect to aortic pathology: 35.6% of the cases (95/267) were aortic dissection, with 74.7% (71/95) being acute and necessitating emergency surgery with deep hypothermic circulatory arrest.

The clinical presentation of acute aortic dissection significantly determines operative risk and mortality, particularly when it is associated with organ ischemia.² Thus this confounding effect of an aortic arch subgroup with distinctive presentations ideally merits a de novo analysis in a large acute aortic dissection series. This goal would require many years to achieve for a single center, however, even a single, high-volume experienced center. As a result, current single-center series, including our own,³ have included acute aortic dissection as a subgroup and thus been unable to escape the confounding effects of the mixed aortic arch cohort.³ I look forward to future multicenter trials with adequate power to examine the RIFLE criteria in aortic arch surgical cohorts stratified by aortic pathology.

I congratulate Arnaoutakis and colleagues¹ again on their important contribution. I look forward to their comments about this aspect of trial design.

References

1. Arnaoutakis GJ, Bihorac A, Martin TD, Hess PJ, Klodell CT, Ejaz AA, et al. RIFLE criteria for acute kidney injury in aortic arch surgery. J Thorac Cardiovasc Surg 2007;134:1554-1561.[Abstract/Free Full Text]
   
2. Geirrson A, Szeto WY, Pochettino A, McGarvey, Keane MG, Woo YJ, et al. Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations. Eur J Cardiothorac Surg 2007;32:255-262.[Abstract/Free Full Text]
   
3. Augoustides JG, Pochettino A, Ochroch EA, Cowie D, Weiner J, Gambone AJ, et al. Renal dysfunction after thoracic aortic surgery requiring deep hypothermic circulatory arrest: definition, incidence, and clinical predictors. J Cardiothorac Vasc Anesth 2006;20:673-677.[Medline]
   

This article has been cited by other articles:

				L. Englberger, R. M. Suri, K. L. Greason, H. M. Burkhart, T. M. Sundt III, R. C. Daly, and H. V. Schaff Deep hypothermic circulatory arrest is not a risk factor for acute kidney injury in thoracic aortic surgery J. Thorac. Cardiovasc. Surg., February 1, 2011; 141(2): 552 - 558. [Abstract] [Full Text] [PDF]

				M. Haase, R. Bellomo, G. Matalanis, P. Calzavacca, D. Dragun, and A. Haase-Fielitz A comparison of the RIFLE and Acute Kidney Injury Network classifications for cardiac surgery-associated acute kidney injury: A prospective cohort study J. Thorac. Cardiovasc. Surg., December 1, 2009; 138(6): 1370 - 1376. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John G.T. Augoustides Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Augoustides, J. G.T. Search for Related Content PubMed Articles by Augoustides, J. G.T. Related Collections Extracorporeal circulation Great vessels