Acute kidney injury after ascending aorta and aortic arch replacement surgery with moderate hypothermia, circulatory arrest and cardiopulmonary bypass

The correlation between deep hypothermic circulatory arrest (DHCA) and cardiopulmonary bypass (CPB) and their effect on renal function is still not clear enough. Renal failure after surgical replacement of ascending aorta in DHCA und CPB in patients due to aneurysm or calcification represents nowadays a major concern. This major study focused on the impact of DHCA and CPB on renal function in those patients. In the presented retrospective cohort study, the database for Kiel University clinic was searched for patients with aortic arch and aortic ascending replacement surgeries with HCA and CPB techniques. Between January 1, 2001, and December 31, 2017. 1359 patients were found in our database with different causes for those operations such as ascending aortic and aortic arch -aneurysm, -dissections or -calcifications, who were operated upon. The patient records were abstracted, and the data were entered into a database and then revised for accuracy by randomly checking chart data with data on the computer. Pre- and postoperative renal function are observed and documented. Acute kidney injury (AKI) was classified according to the current ‘Kidney Disease: Improving Global Outcomes’ (KDIGO} Guidelines. The potential correlation of the length of DHCA-CPBT and worsening renal function was evaluated using Spearman’s rank correlation. The data obtained from our analysis outlined the predictive role of longer moderate HCA and CPB times a for AKI. The complex multifactorial pathophysiology plays an underlying prognostic role regarding the outcome for this life-threatening complication and requires more focused clinical trials to illustrate the contradicting results from the previous analyses regarding the causing pathophysiology. In addition to that we found out that the incidence of AKI after ascending aorta and aortic arch replacement surgery using moderate HCA and CPB is approximately 15 %. And those patients with Postopertaitve AKI have an increase in the mortaliy rate by more than 6 times and 3 times longer ICU stay


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