Does deeper hypothermia reduce the risk of acute kidney injury after circulatory arrest for aortic arch surgery?

Conference Paper

OBJECTIVES: The impact of hypothermic circulatory arrest (HCA) temperature on postoperative acute kidney injury (AKI) has not been evaluated. This study examined the association between circulatory arrest temperatures and AKI in patients undergoing proximal aortic surgery with HCA. METHODS: A total of 759 consecutive patients who underwent proximal aortic surgery (ascending ± valve ± root) including arch replacement requiring HCA between July 2005 and December 2016 were identified from a prospectively maintained institutional aortic surgery database. The primary outcome was AKI as defined by Risk, Injury, Failure, Loss, End Stage Renal Disease (ESRD) criteria. The association between minimum nasopharyngeal (NP) and bladder temperatures during HCA and postoperative AKI was assessed, adjusting for patient-level factors using multivariable logistic regression. RESULTS: A total of 85% (n = 645) of patients underwent deep hypothermia (14.1-20.0°C), 11% (n = 83) low-moderate hypothermia (20.1-24.0°C) and 4% (n = 31) high-moderate hypothermia (24.1-28.0°C) as classified by NP temperature. When analysed by bladder temperature, 59% (n = 447) underwent deep hypothermia, 22% (n = 170) low-moderate, 16% (n = 118) high-moderate and 3% mild (n = 24) (28.1-34.0°C) hypothermia. The median systemic circulatory arrest time was 17 min. The incidence of AKI did not differ between hypothermia groups, whether analysed using minimum NP or bladder temperature. In the multivariable analysis, the association between degree of hypothermia and AKI remained non-significant whether analysed as a categorical variable (hypothermia group) or as a continuous variable (minimum NP or bladder temperature) (all P > 0.05). CONCLUSIONS: In patients undergoing proximal aortic surgery including arch replacement requiring HCA, degree of systemic hypothermia was not associated with the risk of AKI. These data suggest that moderate hypothermia does not confer increased risk of AKI for patients requiring circulatory arrest, although additional prospective data are needed.

Full Text

Duke Authors

Cited Authors

  • Vekstein, AM; Yerokun, BA; Jawitz, OK; Doberne, JW; Anand, J; Karhausen, J; Ranney, DN; Benrashid, E; Wang, H; Keenan, JE; Schroder, JN; Gaca, JG; Hughes, GC

Published Date

  • July 30, 2021

Published In

Volume / Issue

  • 60 / 2

Start / End Page

  • 314 - 321

PubMed ID

  • 33624004

Pubmed Central ID

  • PMC8327198

Electronic International Standard Serial Number (EISSN)

  • 1873-734X

Digital Object Identifier (DOI)

  • 10.1093/ejcts/ezab044

Conference Location

  • Germany