• John G T Augoustides, Alberto Pochettino, E Andrew Ochroch, Doreen Cowie, Justin Weiner, Andrew J Gambone, Dawn Pinchasik, Joseph E Bavaria, and David R Jobes.
• Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283, USA. yiandoc@hotmail.com <yiandoc@hotmail.com>
• J. Cardiothorac. Vasc. Anesth. 2006 Oct 1;20(5):673-7.

ObjectiveThe purpose of this study was to evaluate renal dysfunction (RD) after thoracic aortic surgery (TAS) requiring deep hypothermic circulatory arrest (DHCA), to determine the influence of definition on RD after TAS-DHCA, to determine univariate predictors of RD after TAS-DHCA, and to determine multivariate predictors for RD TAS-DHCA. RD was defined in 3 ways: (1) >25% reduction in creatinine clearance, (2) >50% increase in serum creatinine, and (3) >50% increase in serum creatinine with an abnormal peak serum creatinine (>1.3 mg/dL for men and >1.0 mg/dL for women).Study DesignRetrospective and observational.Study SettingSingle large university hospital.ParticipantsAll adults requiring TAS-DHCA in 2000 and 2001.Main ResultsThe cohort size was 144. Antifibrinolytic exposure was 100%: aprotinin 66% and aminocaproic acid 34%. The incidence of RD TAS-DHCA was 22.9% to 38.2%, depending on the definition. The incidence of renal replacement therapy was 2.8%. Multivariate predictors for RD after TAS-DHCA were sepsis, aprotinin exposure, preoperative hypertension, age, and donor exposures.ConclusionsAlthough RD after TAS-DHCA varies substantially because of definition, it is still very common. Its multivariate predictors merit further focused research to enhance perioperative protection of the kidney.

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