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

IF 2.1 Q2 UROLOGY & NEPHROLOGY

International Journal of Nephrology and Renovascular Disease Pub Date : 2022-09-26 eCollection Date: 2022-01-01 DOI:10.2147/IJNRD.S373828

Masahide Higo, Yoshio Shimizu, Keiichi Wakabayashi, Takehiko Nakano, Yasuhiko Tomino, Yusuke Suzuki

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引用次数: 0

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.

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查看原文本刊更多论文

深低温循环停搏(DHCA)在主动脉弓手术中的应用。

背景:虽然深低温循环停搏(DHCA)是主动脉弓手术中保护中枢神经系统的有效选择，但同时肾缺血的影响仍然存在争议。患者和方法:这是一项回顾性观察性研究。本研究纳入63例合并DHCA的胸主动脉手术患者和24例未合并DHCA的心脏手术患者。评估每位患者的平均年龄、术前血清肌酐(Cr)水平、术前估计肾小球滤过率(eGFR)、术后48小时的血清Cr峰值水平、与术前血清Cr相比的Cr升高率、术后48小时的尿量率以及使用KDIGO标准的AKI分期。观察术后3个月临床指标及术后3个月死亡率。比较有和无DHCA患者肾功能或AKI分期分布的平均值。再根据缺血时间对DHCA患者进行分组，比较各组肾功能、AKI分期分布及死亡率。结果:有DHCA的AKI指标明显加重于无DHCA的患者。缺血状态超过40分钟的患者术后48小时血清Cr峰值、血清Cr升高率显著高于未缺血状态的患者。AKI分期的分布与缺血持续时间有关。DHCA患者术后3个月死亡率明显高于无DHCA患者。局限性:本研究存在回顾性设计、患者数量少等局限性，数据有待其他前瞻性研究的证实。结论:DHCA与AKI术后48小时及术后3个月内死亡密切相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Nephrology and Renovascular Disease UROLOGY & NEPHROLOGY-

CiteScore

3.90

自引率

5.00%

发文量

审稿时长

16 weeks

期刊介绍： International Journal of Nephrology and Renovascular Disease is an international, peer-reviewed, open-access journal focusing on the pathophysiology of the kidney and vascular supply. Epidemiology, screening, diagnosis, and treatment interventions are covered as well as basic science, biochemical and immunological studies. In particular, emphasis will be given to: -Chronic kidney disease- Complications of renovascular disease- Imaging techniques- Renal hypertension- Renal cancer- Treatment including pharmacological and transplantation- Dialysis and treatment of complications of dialysis and renal disease- Quality of Life- Patient satisfaction and preference- Health economic evaluations. The journal welcomes submitted papers covering original research, basic science, clinical studies, reviews & evaluations, guidelines, expert opinion and commentary, case reports and extended reports. The main focus of the journal will be to publish research and clinical results in humans but preclinical, animal and in vitro studies will be published where they shed light on disease processes and potential new therapies and interventions.