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

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:

• deep hypothermic circulatory arrest
• DHCA
• ischemia
• acute kidney injury
• AKI
• KDIGO criteria

Data Sharing Statement

The data that support the findings of this study are available on request from the corresponding author, Y.S. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

Ethics Approval Statement

This study was approved by the Ethics Committee of the Juntendo University Hospital and carried out in accordance with Declaration of Helsinki principles (No. E21-0143).

Acknowledgments

We are indebted to the nephrologists, cardiac surgeons, nursing and clinical engineering staff at the Juntendo University Shizuoka Hospital for their collaboration and participation in this study. We also thank to Dr Keiichi Tambara for his technical advices.

Author Contributions

All the authors made a significant contribution to the work reported, whether that is in conception, study design, execution, acquisition data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflicts of interest associated with this paper.

Additional information

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.