title: Acute kidney injury after total aortic arch repair with moderate hypothermic circulatory arrest.
abstract: OBJECTIVE
  The aim of this study is to evaluate acute kidney injury (AKI) after total aortic arch repair (TAR) with moderate hypothermic circulatory arrest (MHCA) and selective antegrade cerebral perfusion (SACP).
  
  
  METHODS
  A retrospective analysis was performed in 200 patients who underwent TAR with HCA and SACP between 2008 and 2012. The AKI severity was classified into three grades (R=risk, I=injury, F=failure) by RIFLE criteria, and patients who required renal replacement therapy were included in grade F.
  
  
  RESULTS
  Postoperative AKI was observed in 88 patients (44%) including 53 RIFLE-R (27%), 18 RIFLE-I (9%), and 17 RIFLE-F (9%). Significantly higher 30-day mortality was observed in AKI (+) group compared with AKI (-) group (10.2% [9/88] vs. 1.8% [2/112]; p=0.012). The three-year survival rate was 85% in AKI (+) group and 93% in AKI (-) group, and log-rank test revealed better survival in AKI (-) group (p=0.022). Multivariate Cox proportional-hazards regression detected AKI (all grades) and cardiac arrest time as predictors of mid-term mortality (hazard ratio [HR]: 3.2, p=0.041 and HR: 1.02, p=0.006, respectively). Multivariate analysis revealed prolonged operative time (≥ 490 min) as an independent risk factor for AKI (all grades), and emergency, atrial fibrillation, operative time (≥ 490 min), and hypothermia (<24 °C) as risk factors for severe AKI (RIFLE-I and -F).
  
  
  CONCLUSIONS
  Postoperative AKI stratified by RIFLE criteria was significantly associated with short- and mid-term outcomes in TAR with MHCA and SACP.
authors: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors: Arudo
authors: A
authors: Hiraoka
authors: Genta
authors: G
authors: Chikazawa
authors: Toshinori
authors: T
authors: Totsugawa
authors: Taichi
authors: T
authors: Sakaguchi
authors: Kentaro
authors: K
authors: Tamura
authors: Hidenori
authors: H
authors: Yoshitaka
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D001281:Atrial Fibrillation; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000379:methods*; D004630:Emergencies; D005260:Female; D006801:Humans; D051034:Inhibitor of Apoptosis Proteins; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D011183:Postoperative Complications / Q000401:mortality*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D000077022:Survivin; D013997:Time Factors; D016896:Treatment Outcome; D029961:Zebrafish Proteins
chemical_list: C541681:Birc5a protein, zebrafish; D051034:Inhibitor of Apoptosis Proteins; D000077022:Survivin; D029961:Zebrafish Proteins