Effect of Deep Hypothermic Circulatory Arrest Versus Moderate Hypothermic Circulatory Arrest in Aortic Arch Surgery on Postoperative Renal Function: A Systematic Review and Meta‐Analysis

Figures

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  Figure 1. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses flowchart of selection.

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  Figure 2. Forest plot of the odds ratio of postoperative renal failure in aortic arch surgery using deep hypothermic circulatory arrest or using moderate hypothermic circulatory arrest. The overall significance of results (odds ratio, 0.76; 95% CI, 0.61–0.94; P=0.011), with the heterogeneity (I2=0.0%, P=0.459). The estimate of the odds ratio of each trial corresponds to the middle of the squares, and the horizontal line shows the 95% CI. On each line, the number of events as a fraction of the total number randomized is shown for both treatment groups. Pooling model using Random (I–V heterogeneity) and the pooled odds ratio estimated by weighting methods. DHCA indicates deep hypothermic circulatory arrest; and MHCA, moderate hypothermic circulatory arrest.

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  Figure 3. Forest plot shows the odds ratio (OR) of renal failure for studies comparing hypothermic circulatory arrest time <30 minutes and >30 minutes. For each subgroup, the sum of the statistics, along with the summary OR, is represented by the middle of the solid diamonds. A test of heterogeneity between the trials within a subgroup is given below the summary statistics. Pooling model using Random (I–V heterogeneity). Significance of result in circulatory arrest time <30 minutes (OR, 0.73; 95% CI, 0.54–0.99; P=0.040; I2=1.1%). While circulatory arrest time longer than 30 minutes subgroup has no significantly result (OR, 0.76; 95% CI, 0.51–1.13; P=0.169; I2=17.3%). Overall significance of results (OR, 0.74; 95% CI, 0.59–0.92; P=0.008; I2=1.0%). DHCA indicates deep hypothermic circulatory arrest; and MHCA, moderate hypothermic circulatory arrest.

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  Figure 4. Begg funnel plot for the meta‐analysis of renal failure comparing DHCA vs MHCA in all 14 included studies. P values for the Begg tests were 0.999. Log of odds ratio comparing renal failure (vertical axis) is presented against the standard error of the log of odds ratios (horizontal axis). The standard error inversely corresponds to study size. Asymmetry of the plot can indicate publication bias. OR indicates odds ratio; and SE, standard error.

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  Figure 5. One‐way sensitivity analysis of renal failure. In this analysis, the omission of each study did not make a significant difference, confirming the stability of our results.