The Influence of Deep Hypothermic Circulatory Arrest on the Incidence of Postoperative Acute Kidney Injury After Pulmonary Endarterectomy
4 affiliations
- 1Department of Anesthesiology, Kerckhoff-Clinic, Campus of Justus-Liebig-University Giessen, 61231 Bad Nauheim, Germany
- 2Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 Düsseldorf, Germany
- 3Department of Thoracic Surgery, Kerckhoff-Clinic, Campus of Justus-Liebig-University Giessen, 61231 Bad Nauheim, Germany
- 4Department of Anesthesiology, Amsterdam University Medical Center (AUMC), Location AMC, 1105 AZ Amsterdam, The Netherlands
Abstract
Background: Pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) is performed using phases of deep hypothermic circulatory arrest (DHCA). DHCA has been discussed as a risk factor for cardiac surgery-associated acute kidney injury (AKI). The study analyzes the influence of the duration of DHCA on the incidence of postoperative AKI in patients undergoing PEA. Methods: This retrospective single-center cohort study included adult CTEPH patients who underwent PEA. The main exposure was DHCA at 18–20 °C core temperature. Primary endpoint was postoperative AKI defined by the KDIGO serum creatinine criteria. Secondary endpoints included severe postoperative AKI, major adverse cardiovascular events and mortality. Univariate and multivariate logistic regression models were performed for risk factor analysis. Results: Four hundred and eighty-three patients were included (mean age 61 ± 13 years). The incidence of postoperative AKI was 50%. Multivariate analysis showed no association between DHCA and AKI. Postoperative AKI was independently associated with chronic kidney disease (OR = 1.76, 95% CI = 1.05–2.95), age (OR = 1.02, 95% CI = 1.00–1.03), cardiopulmonary bypass (CPB) time (OR = 1.01, 95% CI = 1.01–1.02) and vasoactive-inotropic score (VIS) (OR = 1.05, 95% CI = 1.01–1.10). Patients with preoperative diuretics had a lower risk for postoperative AKI (OR = 0.44, 95% CI = 0.29–0.66). MACE were more frequent in patients with postoperative AKI (28.4% vs. 14.2%, p < 0.001), whereas 30-day and 1-year mortality did not differ. Conclusions: Results from this study indicate no influence of DHCA duration on occurrence of postoperative AKI. Risk factors identified for postoperative AKI were chronic kidney disease, age, CPB duration and VIS.
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BibTeX
@article{zdravkovic2026influence,
title = {{The Influence of Deep Hypothermic Circulatory Arrest on the Incidence of Postoperative Acute Kidney Injury After Pulmonary Endarterectomy}},
author = {Dina Zdravković and Nikolaos Lafioniatis and Paraskevi Tsimpoura and René M’Pembele and Sebastian Roth and Eckhard Mayer and Christoph B. Wiedenroth and Stefan Guth and Ragnar Huhn and Carolin Torregroza},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207931},
url = {https://www.mdpi.com/2077-0383/15/20/7931},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The Influence of Deep Hypothermic Circulatory Arrest on the Incidence of Postoperative Acute Kidney Injury After Pulmonary Endarterectomy
AU - Dina Zdravković
AU - Nikolaos Lafioniatis
AU - Paraskevi Tsimpoura
AU - René M’Pembele
AU - Sebastian Roth
AU - Eckhard Mayer
AU - Christoph B. Wiedenroth
AU - Stefan Guth
AU - Ragnar Huhn
AU - Carolin Torregroza
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207931
UR - https://www.mdpi.com/2077-0383/15/20/7931
AB - Background: Pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) is performed using phases of deep hypothermic circulatory arrest (DHCA). DHCA has been discussed as a risk factor for cardiac surgery-associated acute kidney injury (AKI). The study analyzes the influence of the duration of DHCA on the incidence of postoperative AKI in patients undergoing PEA. Methods: This retrospective single-center cohort study included adult CTEPH patients who underwent PEA. The main exposure was DHCA at 18–20 °C core temperature. Primary endpoint was postoperative AKI defined by the KDIGO serum creatinine criteria. Secondary endpoints included severe postoperative AKI, major adverse cardiovascular events and mortality. Univariate and multivariate logistic regression models were performed for risk factor analysis. Results: Four hundred and eighty-three patients were included (mean age 61 ± 13 years). The incidence of postoperative AKI was 50%. Multivariate analysis showed no association between DHCA and AKI. Postoperative AKI was independently associated with chronic kidney disease (OR = 1.76, 95% CI = 1.05–2.95), age (OR = 1.02, 95% CI = 1.00–1.03), cardiopulmonary bypass (CPB) time (OR = 1.01, 95% CI = 1.01–1.02) and vasoactive-inotropic score (VIS) (OR = 1.05, 95% CI = 1.01–1.10). Patients with preoperative diuretics had a lower risk for postoperative AKI (OR = 0.44, 95% CI = 0.29–0.66). MACE were more frequent in patients with postoperative AKI (28.4% vs. 14.2%, p < 0.001), whereas 30-day and 1-year mortality did not differ. Conclusions: Results from this study indicate no influence of DHCA duration on occurrence of postoperative AKI. Risk factors identified for postoperative AKI were chronic kidney disease, age, CPB duration and VIS.
SN - 2077-0383
ER -