The Impact of Deep Versus Moderate Hypothermia on Postoperative Kidney Function After Elective Aortic Hemiarch Repair

Autor: Prashanth Vallabhajosyula, Rita K. Milewski, Suveeksha Naidu, Mary Siki, Joseph E. Bavaria, Ibrahim Sultan, George J. Arnaoutakis, W. Clark Hargrove, Wilson Y. Szeto, Matthew L. Williams, Nimesh D. Desai
Rok vydání: 2016
Předmět:
Male
Databases
Factual
medicine.medical_treatment
Aorta
Thoracic
030204 cardiovascular system & hematology
law.invention
Cohort Studies
Aortic aneurysm
Postoperative Complications
0302 clinical medicine
Hypothermia
Induced
law
Cause of Death
Hospital Mortality
Ejection fraction
Acute kidney injury
Acute Kidney Injury
Middle Aged
Perfusion
Circulatory Arrest
Deep Hypothermia Induced
Treatment Outcome
Elective Surgical Procedures
Cerebrovascular Circulation
Anesthesia
Deep hypothermic circulatory arrest
Female
Cardiology and Cardiovascular Medicine
Glomerular Filtration Rate
Pulmonary and Respiratory Medicine
medicine.medical_specialty
03 medical and health sciences
medicine
Cardiopulmonary bypass
Humans
Rifle
Cerebral perfusion pressure
Dialysis
Aged
Retrospective Studies
Aortic Aneurysm
Thoracic
business.industry
medicine.disease
Survival Analysis
Surgery
Logistic Models
030228 respiratory system
Multivariate Analysis
business
Follow-Up Studies
Zdroj: The Annals of Thoracic Surgery. 102:1313-1321
ISSN: 0003-4975
DOI: 10.1016/j.athoracsur.2016.04.007
Popis: Background There remains concern that moderate hypothermic circulatory arrest (MHCA) with antegrade cerebral perfusion (ACP) may provide suboptimal distal organ protection compared with deep hypothermic circulatory arrest (DHCA) with retrograde cerebral perfusion (RCP). We compared postoperative acute kidney injury (AKI) in in patients who underwent elective hemiarch repair with either DHCA/RCP or MHCA/ACP. Methods This was a retrospective review of all patients undergoing elective aortic hemiarch reconstruction for aneurysmal disease between 2009 and 2014. Patients were stratified according to the use of DHCA/RCP versus MHCA/ACP. The primary outcome was the occurrence of AKI at 48 hours, as defined by the Risk, Injury, Failure, Loss, End-Stage (RIFLE ) criteria. A multivariable logistic regression identified risk factors for AKI. Results One hundred eighteen patients who underwent ACP and 471 patients who underwent RCP were included. The mean lowest temperature was 26.4°C in patients who underwent MHCA/ACP and 17.5°C in patients who underwent DHCA/RCP. Baseline demographics were similar except that patients who underwent DHCA/RCP were more likely to have peripheral arterial disease or bicuspid aortic valves. Cardiopulmonary bypass and aortic cross-clamp times were shorter in the MHCA/ACP group. AKI occurred in 19 (16.2%) patients who underwent MHCA/ACP and 67 (14.3%) patients who underwent DHCA/RCP. Four (0.8%) patients who underwent DHCA/RCP required postoperative dialysis. In-hospital mortality tended to increase with increasing RIFLE classification (RIFLE class-0 (No AKI) = 0.41%; Risk=1.35%, and Injury=10.0%; p = 0.09). On multivariable analysis, the lowest temperature and cerebral perfusion strategy were not significant predictors of AKI. Lower baseline glomerular filtration rate (GFR), lower preoperative ejection fraction, and longer cardiopulmonary bypass (CPB) time were independently associated with higher AKI. Conclusions We applied the sensitive RIFLE criteria to examine AKI in patients undergoing elective aortic hemiarch replacement for aneurysmal disease. Baseline renal dysfunction, lower ejection fraction, and longer CPB time are independent predictors of AKI. Compared with DHCA/RCP, our data suggest that an MHCA/ACP cerebral protection strategy does not appear to be associated with worse postoperative renal outcomes.
Databáze: OpenAIRE
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