Post-Operative Kidney Function Using Deep Hypothermic Circulatory Arrest (DHCA) in Aortic Arch Operation

Masahide Higo; Yoshio Shimizu; Keiichi Wakabayashi; Takehiko Nakano; Yasuhiko Tomino; Yusuke Suzuki

doi:10.2147/IJNRD.S373828

Post-Operative Kidney Function Using Deep Hypothermic Circulatory Arrest (DHCA) in Aortic Arch Operation

Int J Nephrol Renovasc Dis. 2022 Sep 26:15:239-252. doi: 10.2147/IJNRD.S373828. eCollection 2022.

Authors

Masahide Higo¹, Yoshio Shimizu^{2

3}, Keiichi Wakabayashi², Takehiko Nakano¹, Yasuhiko Tomino⁴, Yusuke Suzuki⁵

Affiliations

¹ Department of Clinical Engineering, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
² Division of Nephrology, Department of Internal Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
³ Shizuoka Medical Research Center for Disaster, Juntendo University, Izunokuni, Shizuoka, Japan.
⁴ Asian Pacific Renal Research Promotion Office, Medical Corporation SHOWAKAI, Shinjuku-ku, Tokyo, Japan.
⁵ Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan.

Abstract

Background: Although deep hypothermic circulatory arrest (DHCA) is a useful option to protect the central nervous system during aortic arch operations, the influence of simultaneous renal ischemia remains controversial.

Patients and methods: This is a retrospective observational study. Sixty-three patients who underwent thoracic aortic surgery with DHCA and 24 patients who underwent cardiac surgery without DHCA were included in this study. The mean age, preoperative serum creatinine (Cr) level, preoperative estimated glomerular filtration rate (eGFR), peak serum Cr level up to 48 hrs post-operative, elevation rate of Cr compared to the preoperative serum Cr, urine volume rate up to 48 hrs post-operative and AKI staging using the KDIGO criteria were estimated for each patient. Clinical parameters for 3 months after the operation and the 3-month post-operative mortality rate were assessed. Mean values indicating kidney function or distribution of the AKI stages were compared between patients with and without DHCA. Patients with DHCA were further divided according to the duration of ischemia to compare the values for the kidney function of each group, distribution of AKI stages and mortality.

Results: The parameters indicating AKI of the patients with DHCA were significantly more severe than those without DHCA. Patients who had undergone an ischemic state for more than 40 min revealed significantly higher peak serum Cr, elevation rate of serum Cr, less urine volume up to 48 hrs post-operative compared with those without DHCA. Distribution of the AKI stages was related to the duration of ischemia. The 3-month post-operative mortality of the patients with DHCA was significantly higher than those without DHCA.

Limitations: This study had limitations such as its retrospective design and small number patients, and the data will be required confirmation with other prospective studies.

Conclusion: DHCA is closely related to AKI up to 48 hrs post-operative and death during the 3 months following surgery.

Keywords: AKI; DHCA; KDIGO criteria; acute kidney injury; deep hypothermic circulatory arrest; ischemia.

Grants and funding

This study was supported by JSPS KAKENHI (grant numbers 26461238 and 17K09039). Shizuoka Medical Research Center for Disaster, Juntendo University, is supported by the supported in part by a Grant-in-Aid for Special Research in Subsidies for ordinary expenses of private schools from The Promotion and Mutual Aid Corporation for Private Schools of Japan.