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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Incidence and outcome of rhabdomyolysis after type A aortic dissection surgery: A retrospective analysis
Praveen C Sivadasan, Cornelia S Carr, Abdul Rasheed A Pattath, Samy Hanoura, Suraj Sudarsanan, Hany O Ragab, Hatem Sarhan, Arunabha Karmakar, Rajvir Singh, Amr S Omar
Praveen C Sivadasan, Abdul Rasheed A Pattath, Samy Hanoura, Suraj Sudarsanan, Hany O Ragab, Amr S Omar, Cardiac Anesthesia and ICU Section, Department of Cardiothoracic Surgery, Hamad Medical Corporation, Doha 3050, Qatar
Cornelia S Carr, Department of Clinical Surgery, College of Medicine, Qatar University, Doha 3050, Qatar
Cornelia S Carr, Hatem Sarhan, Department of Cardiothoracic Surgery, Hamad Medical Corporation, Doha 3050, Qatar
Samy Hanoura, Hany O Ragab, Department of Anesthesia and Intensive Care, Al-Azhar University, Cairo 11651, Egypt
Hatem Sarhan, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44106, United States
Arunabha Karmakar, Department of Medical Education, Hamad Medical Corporation, Doha 3050, Qatar
Rajvir Singh, Department of Medical Research, Hamad Medical Corporation, Doha 3050, Qatar
Amr S Omar, Department of Critical Care Medicine, Beni Suef University, Beni Suef 2722165, Egypt
Author contributions: Omar AS, Sivadasan PC, Singh R designed and conceptualized the study and performed patient enrollment screening; Sivadasan PC, Sudarsanan S, Hanoura S, Ragab HO, Sarhan H, Karmakar A completed the data collection and charting; Sivadasan PC, Omar AS, Sudarsanan S, Hanoura S contributed to data management and interpretation, formulating discussion and conclusion; Carr CS, Pattath AA reviewed scientific content and English grammar of the manuscript, provided administrative support; Singh R did the statistical analysis.
Supported by Hamad Medical Corporation, No. MRC-01-18-073.
Institutional review board statement: The Corporate Institutional Review Board approved the study with reference number MRC-01-17-058.
Informed consent statement: Since it was a retrospective review, the ethics committee granted a waiver of informed consent. However, the patient data were deidentified and then stored anonymously using computer-generated codes.
Conflict-of-interest statement: All authors declared no conflict of interest in relation to this publication.
Data sharing statement: The manuscript-related data and materials are available in Hamad Medical Corporation Medical Research Center database. Subject to approval from the medical research center of Hamad Medical Corporation, data will be made available on request to the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Praveen C Sivadasan, Cardiac Anesthesia and ICU Section, Department of Cardiothoracic Surgery, Hamad Medical Corporation, Al Rayyan Road, Doha 3050, Qatar.
psivadasan@hamad.qa
Received: June 14, 2024
Revised: October 27, 2024
Accepted: December 10, 2024
Published online: June 9, 2025
Processing time: 257 Days and 11.4 Hours
BACKGROUND
Rhabdomyolysis (RML) as an etiological factor causing acute kidney injury (AKI) is sparsely reported in the literature.
AIM
To study the incidence of RML after surgical repair of an ascending aortic dissection (AAD) and to correlate with the outcome, especially regarding renal function. To pinpoint the perioperative risk factors associated with the development of RML and adverse renal outcomes after aortic dissection repair.
METHODS
Retrospective single-center cohort study conducted in a tertiary cardiac center. We included all patients who underwent AAD repair from 2011-2017. Post-operative RML workup is part of the institutional protocol; studied patients were divided into two groups: Group 1 with RML (creatine kinase above cut-off levels 2500 U/L) and Group 2 without RML. The potential determinants of RML and impact on patient outcome, especially postoperative renal function, were studied. Other outcome parameters studied were markers of cardiac injury, length of ventilation, length of stay in the intensive care unit), and length of hospitalization.
RESULTS
Out of 33 patients studied, 21 patients (64%) developed RML (Group RML), and 12 did not (Group non-RML). Demographic and intraoperative factors, notably body mass index, duration of surgery, and cardiopulmonary bypass, had no significant impact on the incidence of RML. Preoperative visceral/peripheral malperfusion, though not statistically significant, was higher in the RML group. A significantly higher incidence of renal complications, including de novo postoperative dialysis, was noticed in the RML group. Other morbidity parameters were also higher in the RML group. There was a significantly higher incidence of AKI in the RML group (90%) than in the non-RML group (25%). All four patients who required de novo dialysis belonged to the RML group. The peak troponin levels were significantly higher in the RML group.
CONCLUSION
In this study, we noticed a high incidence of RML after aortic dissection surgery, coupled with an adverse renal outcome and the need for post-operative dialysis. Prompt recognition and management of RML might improve the renal outcome. Further large-scale prospective trials are warranted to investigate the predisposing factors and influence of RML on major morbidity and mortality outcomes.
Core Tip: Renal complications contribute significantly to postoperative morbidity and mortality. Rhabdomyolysis (RML) is one of the etiological factors leading to tubular damage and acute kidney injury (AKI) perioperatively. There is no robust data on RML after ascending aortic dissection (AAD) surgery. Our single-center retrospective study, among AAD patients, evaluated the incidence of RML and its impact on renal outcome-We found a relatively high incidence (64%) of RML coupled with a higher rate of AKI and the need for renal replacement therapy. Further prospective studies are warranted to identify the risk factors of RML and its impact on outcomes.
