Acute kidney injury after total aortic arch repair with moderate hypothermic circulatory arrest

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).

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.

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).

Postoperative AKI stratified by RIFLE criteria was significantly associated with short- and mid-term outcomes in TAR with MHCA and SACP.