• Diane Hu, David Blitzer, Yanling Zhao, Christine Chan, Tsuyoshi Yamabe, Ilya Kim, Adedeji Adeniyi, Christian Pearsall, Paul Kurlansky, Isaac George, Craig R Smith, Virendra Patel, and Hiroo Takayama.
• Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY; Columbia Aortic Center, New York, NY.
• J. Thorac. Cardiovasc. Surg. 2023 Dec 1; 166 (6): 17071716.e61707-1716.e6.

ObjectivesWe aim to investigate the association between parameters surrounding circulatory arrest and postoperative acute kidney injury in aortic surgery.MethodsThis is a single-center retrospective study of 1118 adult patients who underwent aortic repair with median sternotomy between January 2010 and May 2019. Acute kidney injury was defined on the basis of a modified version of the 2012 Kidney Disease Improving Global Outcomes Scale that excluded urine output. The primary outcome of interest was any stage of acute kidney injury.ResultsCirculatory arrest was required in 369 patients, and 307 patients (27.5%) developed acute kidney injury: stage 1 in 241 patients, stage 2 in 38 patients, and stage 3 in 28 patients. Lower-body ischemia (the period during circulatory arrest without blood flow to kidneys) duration was not associated with acute kidney injury after multivariable logistic regression (1-40 minutes, odds ratio, 0.67; 95% confidence interval, 0.43-1.04; P = .075; >40 minutes, odds ratio, 0.67; 95% confidence interval, 0.29-1.55; P = .356). Hypertension (odds ratio, 1.65; 95% confidence interval, 1.09-2.54; P = .020), preoperative estimated glomerular filtration rate (odds ratio, 0.99; 95% confidence interval, 0.98-1.00; P = .010), packed red blood cell transfusion volume (odds ratio, 1.00; 95% confidence interval, 1.00-1.00; P = .028), and nadir temperature (odds ratio, 0.93; 95% confidence interval, 0.88-0.99; P = .013) were independently associated with acute kidney injury after multivariable analysis. Although there was a positive association between lower-body ischemia duration and development of acute kidney injury with univariable cubic spline, the positive curve was flattened after adjustment for the described variables.ConclusionsWithin the range of our clinical practice, prolonged lower-body ischemia duration was not independently associated with postoperative acute kidney injury, whereas nadir temperature was.Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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