Acute Kidney Injury After Neonatal Aortic Arch Surgery: Deep Hypothermic Circulatory Arrest Versus Moderate Hypothermia With Distal Aortic Perfusion

2021 ◽  
Vol 12 (5) ◽  
pp. 573-580 ◽  
Author(s):  
Wolfgang Böttcher ◽  
Viktoria Weixler ◽  
Mathias Redlin ◽  
Peter Murin ◽  
Frank Dehmel ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Kidney Injury ◽  
Deep Hypothermic Circulatory Arrest ◽  
Moderate Hypothermia ◽  
Aortic Arch Repair ◽  
Stage 1 ◽  
Aortic Perfusion ◽  
Distal Aortic Perfusion

Background: Acute kidney injury (AKI) is a common complication observed after neonatal aortic arch repair. We studied its incidence after procedures carried out using deep hypothermic circulatory arrest (DHCA) versus moderate hypothermia with distal aortic perfusion (MHDP), usually through the common femoral artery. In both groups, continuous regional cerebral perfusion (RCP) was used during the time required for aortic arch repair. Methods: A total of 125 neonates underwent aortic arch repair. Between 2007 and 2012, DHCA with RCP was used in 51 neonates. From 2013 to 2019, MHDP with RCP was performed on 74 newborns. Operative complexity was similar in both periods. Acute kidney injury was defined as a significant elevation of serum creatinine and was classified according to the neonatal modified n-KDIGO (neonatal Kidney Disease: Improving Global Outcomes) stages 1 to 3 (Kidney Disease Improving: Global Outcomes). Results: Acute kidney injury was observed in a total of 68 patients (68/125: 54.4%). In the majority (44/68: 64.7%), n-KDIGO stage 1 occurred. Stage 2 (n = 14) and stage 3 (n = 10) were observed more frequently after DHCA versus MHDP: 29.4% (15/51) versus 12.2% (9/74), P = .02. At cardiopulmonary bypass end, lactate levels were significantly higher ( P = .001) after DHCA: 3.4 (2.9-4.3) mmol/L compared to 2.7 (2.3-3.7) mmol/L after MHDP. Early mortality was 12% (15/125) in the entire cohort. It was 17.6% (9/51) after DHCA versus 8.1% (6/74) after MHDP, however not statistically significant ( P = .16). Conclusion: Mild (stage 1) AKI occurred frequently after neonatal aortic arch repair. The use of MHDP was associated with a significantly lower incidence of moderate (stage 2) and severe (stage 3) AKI forms.

Acute Kidney Injury After Total Aortic Arch Repair with Moderate Hypothermic Circulatory Arrest

2013 ◽  
Vol 29 (2) ◽  
pp. 218-224 ◽  
Author(s):  
Arudo Hiraoka ◽  
Genta Chikazawa ◽  
Toshinori Totsugawa ◽  
Taichi Sakaguchi ◽  
Kentaro Tamura ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Kidney Injury ◽  
Hypothermic Circulatory Arrest ◽  
Aortic Arch Repair

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

2021 ◽  
Author(s):  
Andrew M Vekstein ◽  
Babtunde A Yerokun ◽  
Oliver K Jawitz ◽  
Julie W Doberne ◽  
Jatin Anand ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Deep Hypothermia ◽  
Moderate Hypothermia ◽  
Bladder Temperature ◽  
Increased Risk ◽  
The Impact

Abstract 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.

scholarly journals Aortic Arch Aneurysm Repair under Deep Hypothermic Circulatory Arrest

2017 ◽  
Vol 6 (1) ◽  
pp. 39-43
Author(s):  
Jeju Nath Pokharel ◽  
MR Upreti ◽  
DR Shakya ◽  
Bhagwan Koirala ◽  
Jyotindra Sharma ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
First Case ◽  
Aortic Arch Repair ◽  
Aneurysm Repair ◽  
Arch Aneurysm ◽  
Antegrade Cerebral Perfusion

A 46 years female underwent aortic arch repair surgery under deep hypothermic circulatory arrest (DHCA) and right antegrade cerebral perfusion. The patient was extubnated after 13 hours of the surgery and discharged from SICU on third post operative day and discharged from hospital on sixth postoperative day uneventfully and with excellent neurological functions. It was the first case of aortic arch repair in our hospital. Combination of DHCA and right antegrade cerebral perfusion may be the reason for better neurological outcome.

Sign in / Sign up

Export Citation Format

Share Document