Stroke volume variation and serum creatinine changes during abdominal aortic aneurysm surgery: a time-integrated...

Area of Science:

• Cardiovascular Surgery
• Nephrology
• Critical Care Medicine

Background:

• Abdominal aortic aneurysm (AAA) surgery with suprarenal clamping poses significant risks for acute kidney injury (AKI) and major adverse cardiac and cerebrovascular events (MACCE).
• Hypertensive patients undergoing elective AAA surgery are particularly vulnerable to these complications.

Purpose of the Study:

• To investigate the association between stroke volume variation (SVV), a hemodynamic instability marker, and the development of AKI.
• To determine if SVV can predict AKI in hypertensive patients undergoing AAA surgery with suprarenal clamping.

Main Methods:

• A cohort of 51 hypertensive patients undergoing AAA surgery was studied.
• Serial measurements of SVV and serum creatinine (sCr) were performed.
• AKI was diagnosed using KDIGO guidelines, and data were analyzed using repeated-measures ANOVA and regression analysis.

Main Results:

• AKI developed in 45% of patients, with varying stages.
• Diuresis, clamp time, and time-integrated changes in SVV were independent predictors of changes in sCr.
• Increased SVV from baseline to 12 hours post-surgery predicted changes in sCr up to 48 hours post-surgery.

Conclusions:

• SVV increases progressively in patients who develop AKI during and after AAA surgery.
• Rising SVV precedes and predicts serum creatinine elevation, serving as a discriminator for AKI development.
• AKI in this cohort was associated with a significantly increased long-term risk of MACCE.