• Guiyu Lei, Guyan Wang, Qing Liu, Hui Zhou, Zhongrong Fang, Congya Zhang, Lijing Yang, Sheng Shi, Jun Li, Yimeng Chen, and Xiying Yang.
• Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
• J. Cardiothorac. Vasc. Anesth. 2019 Dec 1; 33 (12): 3294-3300.

ObjectivesThe authors compared the renal outcomes of single-stage hybrid aortic arch repair without deep hypothermic circulatory arrest versus conventional total arch replacement in management of thoracic aortic diseases.Design, Setting, And ParticipantsA retrospective review from January 2013 to December 2016 in Fuwai Hospital of 757 consecutive patients who underwent aortic arch repair: conventional total arch replacement (CTAR, 651), and hybrid arch repair (HAR, 106), with propensity matching (95 pairs).Measurements And Main ResultsThe primary end-point was postoperative acute kidney injury (AKI) defined using the Kidney Disease Improving Global Outcome criteria. The secondary end-point was short-term outcomes such as in-hospital mortality and paraplegia determined by the Society of Thoracic Surgeons. The patients in the HAR group were older (60.20 ± 9.95 v 46.43 ± 10.79, p < 0.0001) and exhibited a greater rate of diabetes (11.3% v 2.0%, p = 0.0004), hyperlipidemia (47.2% v 25.4%, p < 0.0001), and coronary artery disease (13.2% v 4.3%, p < 0.0001) than those in the CTAR group. Following propensity score matching of 95 matched pairs, the difference in preoperative risk diminished. The HAR group led to a shorter cardiopulmonary bypass time (133.33 ± 41.47 v 179.62 ± 40.79, p < 0.0001) and avoided circulatory arrest. The incidence of postoperative AKI between HAR and CTAR groups was significantly different (before match: 75.5% v 59.45%, p = 0.0046; after match: 78.9% v 57.9%, p = 0.0008).ConclusionIn the management of thoracic aortic diseases, HAR is associated with a significantly lower incidence of postoperative AKI, and showed equivalent short-term outcomes despite the older age compared with the CTAR group.Copyright © 2019 Elsevier Inc. All rights reserved.

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