Single-Stage Hybrid Aortic Arch Repair is Associated With a Lower Incidence of Postoperative Acute Kidney Injury Than Conventional Aortic Surgery.

OBJECTIVES: The 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 PARTICIPANTS: A 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 RESULTS: The 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).

CONCLUSION: In 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.