Key result
Systemic hypothermia depth during aortic surgery is not linked to postoperative AKI risk.
Why the study?
The impact of hypothermic circulatory arrest temperature on postoperative acute kidney injury has not been evaluated in proximal aortic surgery patients.
Does moderate hypothermia compared to deep hypothermia reduce the risk of acute kidney injury in patients undergoing proximal aortic surgery with hypothermic circulatory arrest?
Cohort (n=759)
No
Does moderate hypothermia compared to deep hypothermia reduce the risk of acute kidney injury in patients undergoing proximal aortic surgery with hypothermic circulatory arrest?
p-value: p=>0.05
Moderate hypothermia does not confer an increased risk of acute kidney injury compared to deep hypothermia during proximal aortic surgery requiring circulatory arrest.
Moderate hypothermia may not increase AKI risk; hypothesis-generating and requires randomized confirmation before practice change.
OBJECTIVES: The impact of hypothermic circulatory arrest (HCA) temperature on postoperative acute kidney injury (AKI) has not been evaluated. This study examined the association between circulatory arrest temperatures and AKI in patients undergoing proximal aortic surgery with HCA. METHODS: A total of 759 consecutive patients who underwent proximal aortic surgery (ascending ± valve ± root) including arch replacement requiring HCA between July 2005 and December 2016 were identified from a prospectively maintained institutional aortic surgery database. The primary outcome was AKI as defined by Risk, Injury, Failure, Loss, End Stage Renal Disease (ESRD) criteria. The association between minimum nasopharyngeal (NP) and bladder temperatures during HCA and postoperative AKI was assessed, adjusting for patient-level factors using multivariable logistic regression. RESULTS: A total of 85% (n = 645) of patients underwent deep hypothermia (14.1-20.0°C), 11% (n = 83) low-moderate hypothermia (20.1-24.0°C) and 4% (n = 31) high-moderate hypothermia (24.1-28.0°C) as classified by NP temperature. When analysed by bladder temperature, 59% (n = 447) underwent deep hypothermia, 22% (n = 170) low-moderate, 16% (n = 118) high-moderate and 3% mild (n = 24) (28.1-34.0°C) hypothermia. The median systemic circulatory arrest time was 17 min. The incidence of AKI did not differ between hypothermia groups, whether analysed using minimum NP or bladder temperature. In the multivariable analysis, the association between degree of hypothermia and AKI remained non-significant whether analysed as a categorical variable (hypothermia group) or as a continuous variable (minimum NP or bladder temperature) (all P > 0.05). CONCLUSIONS: In patients undergoing proximal aortic surgery including arch replacement requiring HCA, degree of systemic hypothermia was not associated with the risk of AKI. These data suggest that moderate hypothermia does not confer increased risk of AKI for patients requiring circulatory arrest, although additional prospective data are needed.
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Vekstein et al. (2021) conducted a cohort in Proximal aortic surgery requiring hypothermic circulatory arrest (n=759). Degree of hypothermia vs. Different degrees of hypothermia (deep vs moderate) was evaluated on Acute kidney injury (AKI) as defined by RIFLE criteria (p=>0.05). The degree of systemic hypothermia during proximal aortic surgery requiring circulatory arrest was not significantly associated with the risk of postoperative acute kidney injury (P>0.05).
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