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.

Risk factors and outcome of aortic surgery patients with hypothermic circulatory arrest: can urine NGAL predict acute kidney injury?

“…There were some limitations of our study. First, it was not a randomized controlled trial study and included quite a small number of subjects when compared to previous studies [ 5 , 15 , 18 , 19 ]. Second, the study groups were small, which may have affected the results.…”

TAK-242 protects against oxygen-glucose deprivation and reoxygenation-induced injury in brain microvascular endothelial cells and alters the expression pattern of lncRNAs

“…Deep hypothermic circulatory arrest (DHCA) is a technique used during the surgical treatment of aneurysms of the thoracic aorta in adult patients, and complex congenital heart disease in neonates ( 1 , 2 ). It involves cooling the patient’s core body temperature and stopping blood circulation ( 3 ). The cessation of bold flow provides an optimal visual field during surgery, and deep hypothermia protects cerebral and other vital organs from ischemia ( 3 ).…”

“…It involves cooling the patient’s core body temperature and stopping blood circulation ( 3 ). The cessation of bold flow provides an optimal visual field during surgery, and deep hypothermia protects cerebral and other vital organs from ischemia ( 3 ). Although the hypothermic state limits cerebral damage by lowering the global cerebral metabolism and oxygen consumption, DHCA-induced hypoxic-ischemic insult is still the leading cause of neuronal injury after surgery involving DHCA ( 3 ).…”

“…The cessation of bold flow provides an optimal visual field during surgery, and deep hypothermia protects cerebral and other vital organs from ischemia ( 3 ). Although the hypothermic state limits cerebral damage by lowering the global cerebral metabolism and oxygen consumption, DHCA-induced hypoxic-ischemic insult is still the leading cause of neuronal injury after surgery involving DHCA ( 3 ). Ischemia and hypoxia results in the excessive and hyperactivity of neuronal cells, which increase the expression of genes that promote oxidation and the caspase family genes to induce the apoptosis, and the adenosine triphosphate deletion leads neuronal cells necrosis ( 4 ).…”