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Updated: Aug 26, 2025

A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion

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

Masahide Higo¹, Yoshio Shimizu^2,3, Keiichi Wakabayashi²

¹Department of Clinical Engineering, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.

International Journal of Nephrology and Renovascular Disease

|October 3, 2022

Summary

Deep hypothermic circulatory arrest (DHCA) during aortic arch surgery is linked to more severe acute kidney injury (AKI) and higher mortality. Longer ischemia times increase AKI severity and post-operative death risk.

Keywords:

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

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Area of Science:

Cardiology
Nephrology
Thoracic Surgery

Background:

Deep hypothermic circulatory arrest (DHCA) is utilized in aortic arch operations to protect the central nervous system.
The impact of DHCA on renal ischemia and subsequent kidney function remains a subject of debate.

Purpose of the Study:

To investigate the relationship between DHCA and acute kidney injury (AKI) in patients undergoing thoracic aortic surgery.
To assess the influence of ischemia duration during DHCA on post-operative kidney function and mortality.

Main Methods:

Retrospective observational study including 63 patients with DHCA and 24 without.
Evaluated pre- and post-operative serum creatinine, estimated glomerular filtration rate, urine output, and AKI staging (KDIGO criteria).
Compared outcomes between patients with and without DHCA, and analyzed effects of ischemia duration in the DHCA group.

Main Results:

Patients undergoing DHCA exhibited significantly more severe AKI parameters compared to those without DHCA.
Ischemia duration exceeding 40 minutes in DHCA patients correlated with higher peak serum creatinine, increased creatinine elevation rate, and reduced urine output.
A higher 3-month post-operative mortality rate was observed in patients who underwent DHCA.

Conclusions:

DHCA is significantly associated with increased risk of AKI within 48 hours post-surgery.
DHCA is linked to a higher incidence of death within 3 months following thoracic aortic surgery.