Commentary: Questioning the importance of the circulatory arrest time in aortic surgery in the postoperative renal function deterioration

Abstract

Central MessageCirculatory arrest time in aortic surgery may not be as important in the postoperative deterioration of the renal function as it was supposed.See Article page XXX. Circulatory arrest time in aortic surgery may not be as important in the postoperative deterioration of the renal function as it was supposed. See Article page XXX. Numerous studies relate hypothermia, due to the possible endothelial injury it generates, with the development of acute kidney injury (AKI) during the postoperative period. However, little is known about the impact that circulatory arrest (CA) time has on the appearance of AKI. There are discrepancies in the few published studies, Nota and colleagues,1Nota H. Asai T. Suzuki T. Kinoshita T. Ikegami H. Takashima N. Risk factors for acute kidney injury in aortic arch surgery with selective cerebral perfusion and mild hypothermic lower body circulatory arrest.Interact Cardiovasc Thorac Surg. 2014; 19: 955-961Crossref PubMed Scopus (26) Google Scholar in a sample of 116 consecutive patients with aortic arch aneurysm, found that there was a relationship between CA time and AKI; on the opposite side, Ghincea and colleagues,2Ghincea C.V. Reece T.B. Eldeiry M. Roda G.F. Bronsert M.R. Jarrett M.J. et al.Predictors of acute kidney injury following aortic arch surgery.J Surg Res. 2019; 242: 40-46Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar in a series of 295 consecutive patients who underwent open aortic arch surgery, and Vekstein and colleagues,3Vekstein A.M. Yerokun B.A. Jawitz O.K. Doberne J.W. Anand J. Karhausen J. et al.Does deeper hypothermia reduce the risk of acute kidney injury after circulatory arrest for aortic arch surgery?.Eur J Cardiothorac Surg. 2021; 60: 314-321Crossref PubMed Scopus (2) Google Scholar in a series of 759 consecutive patients who underwent proximal aortic surgery, did not observe that CA time was a risk factor for AKI. This last group also establishes that AKI is independent of the degree of hypothermia. Hu and colleagues4Hu D. Blitzer D. Zhao Y. Chan C. Yamabe T. Kim I. et al.Quantifying the effects of circulatory arrest on acute kidney injury in aortic surgery.J Thorac Cardiovasc Surg. April 6, 2022; ([Epub ahead of print])Abstract Full Text PDF Scopus (1) Google Scholar conclude that CA time is not a determining factor in the development of AKI. This aspect can be of great importance for surgical practice. It would be very important to know at what temperature the CA was performed and if it was the same in all cases. This would allow us to know the possible relationship between temperature ranges in which CA is performed and its influence on the development of AKI and would even allow us to know what the optimal temperature range in which to perform CA to reduce the appearance of AKI is. Otherwise, temperature was measured through the skin and nasopharynx; it would be more appropriate to have determined the bladder temperature, since it better reflects the visceral temperature. Relevant information that they report is that “LBI duration 1-40 minutes 301 (OR, 0.59 [95% CI, 0.38, 0.90], P = .015) was associated with less AKI compared to the no CA”4Hu D. Blitzer D. Zhao Y. Chan C. Yamabe T. Kim I. et al.Quantifying the effects of circulatory arrest on acute kidney injury in aortic surgery.J Thorac Cardiovasc Surg. April 6, 2022; ([Epub ahead of print])Abstract Full Text PDF Scopus (1) Google Scholar; this could be in relationship to ischemic preconditioning, as occurs in other clinical contexts, and that could have repercussions in clinical practice.5Pan T. Jia P. Chen N. Fang Y. Liang Y. Guo M. et al.Delayed remote ischemic preconditioning confers renoprotection against septic acute kidney injury via exosomal miR-21.Theranostics. 2019; 9: 405-423Crossref PubMed Scopus (89) Google Scholar Quantifying the effects of circulatory arrest on acute kidney injury in aortic surgeryThe Journal of Thoracic and Cardiovascular SurgeryPreviewWe aim to investigate the association between parameters surrounding circulatory arrest and postoperative acute kidney injury in aortic surgery. Full-Text PDF