• Brian C Ayers, Raimon Padrós-Valls, Sarah Brownlee, Benjamin S Steinhorn, Kenneth Shann, Asishana Osho, Thoralf M Sundt, and Aaron D Aguirre.
• Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
• J. Cardiothorac. Vasc. Anesth. 2024 Nov 12.

ObjectivesOptimal blood pressure goals during cardiopulmonary bypass (CPB) remain uncertain and new metrics to individualize perfusion targets are needed. Critical closing pressure (Pcrit) is a fundamental property of the arterial circulation related to vascular tone and represents the outflow pressure impacting flow across the systemic circulation. We examined Pcrit as a prognostic marker of acute kidney injury (AKI).DesignRetrospective cohort study.SettingSingle tertiary care hospital PARTICIPANTS: We included 1,038 adult cardiac surgery patients who underwent CPB.InterventionsPcrit was calculated using arterial waveform data before initiation of CPB. Pcrit was examined in relation to incidence of stage 2 or higher postoperative AKI according to standard Kidney Disease Improving Global Outcomes definitions.Measurements And Main ResultsOf the 1,038 patients included in the study, 50 (5%) experienced AKI. Patients who suffered AKI had significantly higher preoperative risk factors, including higher incidence of severe chronic kidney disease and higher Society of Thoracic Surgeons risk score (p < 0.01). They also had longer operative times and longer cross-clamp times (p < 0.01). All patients were maintained at similar mean arterial pressure while on CPB. Patients who suffered AKI had a significantly higher prebypass Pcrit than those who did not (49.0 mmHg vs 44.1 mmHg; p = 0.018). In a multivariate regression, Pcrit remained a significant predictor, representing a 16% increased risk of AKI for each 5 mmHg increase in prebypass Pcrit (p = 0.011).ConclusionsA higher prebypass Pcrit is associated with a significantly higher incidence of postoperative AKI. Future study is warranted to investigate using intraoperative Pcrit to determine a personalized blood pressure goal during CPB.Copyright © 2024 Elsevier Inc. All rights reserved.

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