{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T16:19:11Z","timestamp":1783786751741,"version":"3.55.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T00:00:00Z","timestamp":1629417600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,18]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>\u2002<\/jats:title><\/jats:sec><jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p>Acute kidney injury (AKI) following surgery involving the heart-lung-machine is associated with high mortality and morbidity. In addition to the known mechanisms, thrombotic microangiopathy (TMA) triggered by the dysregulation of complement activation was recently described as another pathophysiological pathway for AKI following aortic surgery. The aim of this retrospective study was to analyse incidence, predictors and outcome in these patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Between January 2018 and September 2019, consecutive patients undergoing aortic surgery requiring hypothermic circulatory arrest were retrospectively reviewed. If suspected, diagnostic algorithm was initiated to identify a TMA and its risk factors, and postoperative outcome parameters were comparably investigated.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The incidence of TMA in the analysed cohort (n\u2009=\u2009247) was 4.5%. Multivariable logistic regression indicated female gender {odds ratio (OR) 4.905 [95% confidence interval (CI) 1.234\u201319.495], P\u2009=\u20090.024} and aortic valve replacement [OR 8.886 (95% CI 1.030\u201376.660), P\u2009=\u20090.047] as independent predictors of TMA, while cardiopulmonary bypass, X-clamp and hypothermic circulatory arrest times showed no statistically significance. TMA resulted in postoperative AKI (82%), neurological disorders (73%) and thrombocytopaenia [31 (interquartile range 25\u201342) G\/l], corresponding to the diagnostic criteria. Operative mortality and morbidity were equal to patients without postoperative TMA, despite a higher incidence of re-exploration for bleeding (27 vs 6%; P\u2009=\u20090.027). After 6\u2009months, survival, laboratory parameters and need for dialysis were comparable between the groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>TMA is a potential differential diagnosis for the cause of AKI following aortic surgery regardless of the hypothermic circulatory arrest time. Timely diagnosis and appropriate treatment resulted in a comparable outcome concerning mortality and renal function.<\/jats:p><\/jats:sec>","DOI":"10.1093\/icvts\/ivab231","type":"journal-article","created":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T19:12:52Z","timestamp":1627499572000},"page":"258-266","source":"Crossref","is-referenced-by-count":4,"title":["Thrombotic microangiopathy following aortic surgery with hypothermic circulatory arrest: a single-centre experience of an underestimated cause of acute renal failure"],"prefix":"10.1093","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8715-4728","authenticated-orcid":false,"given":"Christine E","family":"Kamla","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, LMU University Hospital , Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Grigorescu-Vlass","sequence":"additional","affiliation":[{"name":"Division Nephrology, Department of Internal Medicine IV, LMU University Hospital , Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dietmar","family":"Wassilowsky","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, LMU University Hospital , Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1001-3596","authenticated-orcid":false,"given":"Michael","family":"Fischereder","sequence":"additional","affiliation":[{"name":"Division Nephrology, Department of Internal Medicine IV, LMU University Hospital , Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Hagl","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, LMU University Hospital , Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3266-9791","authenticated-orcid":false,"given":"Ulf","family":"Sch\u00f6nermarck","sequence":"additional","affiliation":[{"name":"Division Nephrology, Department of Internal Medicine IV, LMU University Hospital , Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2903-2490","authenticated-orcid":false,"given":"Maximilian A","family":"Pichlmaier","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, LMU University Hospital , Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1880-152X","authenticated-orcid":false,"given":"Sven","family":"Peterss","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, LMU University Hospital , Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3995-8737","authenticated-orcid":false,"given":"Dominik","family":"J\u00f3skowiak","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, LMU University Hospital , Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,8,20]]},"reference":[{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"1554","DOI":"10.1016\/j.jtcvs.2007.08.039","article-title":"RIFLE criteria for acute kidney injury in aortic arch surgery","volume":"134","author":"Arnaoutakis","year":"2007","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/j.jtcvs.2010.02.045","article-title":"Deep hypothermic circulatory arrest is not a risk factor for acute kidney injury in thoracic aortic surgery","volume":"141","author":"Englberger","year":"2011","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1053\/j.jvca.2013.04.007","article-title":"Simplified clinical risk score to predict acute kidney injury after aortic surgery","volume":"27","author":"Kim","year":"2013","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.jtcvs.2015.04.008","article-title":"Risk factors for acute kidney injury after surgery of the thoracic aorta using antegrade selective cerebral perfusion and moderate hypothermia","volume":"150","author":"Pacini","year":"2015","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.jss.2019.03.055","article-title":"Predictors of acute kidney injury following aortic arch surgery","volume":"242","author":"Ghincea","year":"2019","journal-title":"J Surg Res"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1186\/s13019-019-0907-x","article-title":"Cardiopulmonary bypass time is an independent risk factor for acute kidney injury in emergent thoracic aortic surgery: a retrospective cohort study","volume":"14","author":"Xu","year":"2019","journal-title":"J Cardiothorac Surg"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.jtcvs.2006.09.045","article-title":"The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion: a propensity score analysis","volume":"133","author":"Kamiya","year":"2007","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"3542","DOI":"10.1161\/01.CIR.96.10.3542","article-title":"Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia","volume":"96","author":"Bruins","year":"1997","journal-title":"Circulation"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"2900","DOI":"10.3390\/jcm9092900","article-title":"Severe acute kidney injury in cardiovascular surgery: thrombotic microangiopathy as a differential diagnosis to ischemia reperfusion injury. A retrospective study","volume":"9","author":"Grigorescu","year":"2020","journal-title":"J Clin Med"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1056\/NEJMra1312353","article-title":"Syndromes of thrombotic microangiopathy","volume":"371","author":"George","year":"2014","journal-title":"N Engl J Med"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1016\/j.semnephrol.2013.08.003","article-title":"Atypical hemolytic uremic syndrome","volume":"33","author":"Kavanagh","year":"2013","journal-title":"Semin Nephrol"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1111\/1744-9987.12763","article-title":"Atypical hemolytic-uremic syndrome: an update on pathophysiology, diagnosis and treatment","volume":"23","author":"Raina","year":"2019","journal-title":"Ther Apher Dial"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s12959-018-0168-2","article-title":"Differences and similarities between disseminated intravascular coagulation and thrombotic microangiopathy","volume":"16","author":"Wada","year":"2018","journal-title":"Thromb J"},{"key":"2023032020064812400_","first-page":"22","article-title":"Diagnosis of atypical hemolytic uremic syndrome and response to eculizumab therapy","volume":"73","author":"Nguyen","year":"2014","journal-title":"Hawaii J Med Public Health"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"i4","DOI":"10.1093\/ejcts\/ezw337","article-title":"Patient management in aortic arch surgery","volume":"51","author":"Peterss","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1093\/ckj\/sfs160","article-title":"The RIFLE and AKIN classifications for acute kidney injury: a critical and comprehensive review","volume":"6","author":"Lopes","year":"2013","journal-title":"Clin Kidney J"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1111\/j.1365-2141.2012.09167.x","article-title":"Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies","volume":"158","author":"Scully","year":"2012","journal-title":"Br J Haematol"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1007\/s00467-018-3933-3","article-title":"Extra-renal manifestations of atypical hemolytic uremic syndrome in children","volume":"33","author":"Fidan","year":"2018","journal-title":"Pediatr Nephrol"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1007\/s00467-018-4039-7","article-title":"Extra-renal manifestations of atypical hemolytic uremic syndrome","volume":"34","author":"Formeck","year":"2019","journal-title":"Pediatr Nephrol"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1093\/ckj\/sfz066","article-title":"Relative incidence of thrombotic thrombocytopenic purpura and haemolytic uraemic syndrome in clinically suspected cases of thrombotic microangiopathy","volume":"13","author":"Sch\u00f6nermarck","year":"2020","journal-title":"Clin Kidney J"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"1844","DOI":"10.2215\/CJN.02210310","article-title":"Relative role of genetic complement abnormalities in sporadic and familial aHUS and their impact on clinical phenotype","volume":"5","author":"Noris","year":"2010","journal-title":"Clin J Am Soc Nephrol"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"2169","DOI":"10.1056\/NEJMoa1208981","article-title":"Terminal complement inhibitor eculizumab in atypical hemolytic-uremic syndrome","volume":"368","author":"Legendre","year":"2013","journal-title":"N Engl J Med"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"50","DOI":"10.2215\/CJN.06440616","article-title":"Pathogenic variants in complement genes and risk of atypical hemolytic uremic syndrome relapse after eculizumab discontinuation","volume":"12","author":"Fakhouri","year":"2017","journal-title":"Clin J Am Soc Nephrol"},{"key":"2023032020064812400_","first-page":"2467953","article-title":"Atypical hemolytic uremic syndrome following acute type A aortic dissection","volume":"2020","author":"Ikushima","year":"2020","journal-title":"Case Rep Hematol"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"e255","DOI":"10.1016\/j.athoracsur.2017.04.008","article-title":"Aortic valve replacement as a trigger of atypical hemolytic uremic syndrome","volume":"104","author":"Markakis","year":"2017","journal-title":"Ann Thorac Surg"},{"key":"2023032020064812400_","first-page":"784943","article-title":"Postoperative atypical hemolytic uremic syndrome associated with complement c3 mutation","volume":"2014","author":"Matsukuma","year":"2014","journal-title":"Case Rep Nephrol"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.atherosclerosis.2007.03.040","article-title":"Complement system is activated in stenotic aortic valves","volume":"196","author":"Helske","year":"2008","journal-title":"Atherosclerosis"},{"key":"2023032020064812400_","first-page":"947","article-title":"Plasma proteomic changes during hypothermic and normothermic cardiopulmonary bypass in aortic surgeries","volume":"34","author":"Oda","year":"2014","journal-title":"Int J Mol Med"},{"key":"2023032020064812400_","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1097\/CCM.0b013e3182377050","article-title":"Rewarming after hypothermia after cardiac arrest shifts the inflammatory balance","volume":"40","author":"Bisschops","year":"2012","journal-title":"Crit Care Med"}],"container-title":["Interactive CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/34\/2\/258\/49571696\/ivab231.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/34\/2\/258\/49571696\/ivab231.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T16:10:39Z","timestamp":1699287039000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/34\/2\/258\/6355313"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,20]]},"references-count":29,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2022,1,18]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivab231","relation":{},"ISSN":["1569-9285"],"issn-type":[{"value":"1569-9285","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,2,1]]},"published":{"date-parts":[[2021,8,20]]}}}