Acute Kidney Injury After Total Aortic Arch Repair with Moderate Hypothermic Circulatory Arrest. Issue 2 (13th December 2013)

• Record Type: Journal Article
• Authors: Hiraoka, Arudo; Chikazawa, Genta; Totsugawa, Toshinori; Sakaguchi, Taichi; Tamura, Kentaro; Yoshitaka, Hidenori
• Is Part Of: Journal of cardiac surgery. Volume 29:Issue 2(2014:Mar.)
• Page Start: 218
• Page End: 224
• Publication Date: 2013-12-13
• Subjects: Heart -- Surgery -- Periodicals; 617.412005
• DOI: 10.1111/jocs.12269
• Languages: English
• ISSNs: 0886-0440

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="jocs12269-sec-0001" sec-type="section"> <title>Background and Aim</title> <p>The aim of this study is to evaluate acute kidney injury (AKI) after total aortic arch repair (TAR) with moderate hypothermic circulatory arrest (MHCA) and selective antegrade cerebral perfusion (SACP).</p> </sec> <sec id="jocs12269-sec-0002" sec-type="section"> <title>Methods</title> <p>A retrospective analysis was performed in 200 patients who underwent TAR with HCA and SACP between 2008 and 2012. The AKI severity was classified into three grades (R = risk, I = injury, F = failure) by RIFLE criteria, and patients who required renal replacement therapy were included in grade F.</p> </sec> <sec id="jocs12269-sec-0003" sec-type="section"> <title>Results</title> <p>Postoperative AKI was observed in 88 patients (44%) including 53 RIFLE‐R (27%), 18 RIFLE‐I (9%), and 17 RIFLE‐F (9%). Significantly higher 30‐day mortality was observed in AKI (+) group compared with AKI (−) group (10.2% [9/88] vs. 1.8% [2/112]; p = 0.012). The three‐year survival rate was 85% in AKI (+) group and 93% in AKI (−) group, and log‐rank test revealed better survival in AKI (−) group (p = 0.022). Multivariate Cox proportional‐hazards regression detected AKI (all grades) and cardiac arrest time as predictors of mid‐term mortality (hazard ratio [HR]: 3.2, p = 0.041 and HR: 1.02, p = 0.006, respectively). Multivariate analysis revealed prolonged operative time (≥490 min) as an independent risk factor for AKI (all grades), and emergency, atrial fibrillation, operative time (≥490 min), and hypothermia (<24 °C) as risk factors for severe AKI (RIFLE‐I and ‐F).</p> </sec> <sec id="jocs12269-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Postoperative AKI stratified by RIFLE criteria was significantly associated with short‐ and mid‐term outcomes in TAR with MHCA and SACP. doi: 10.1111/jocs.12269 <italic>(J Card Surg 2014;29:218–224)</italic></p> </sec> </abstract>