Renal injury
Postoperative kidney injury frequently results from the extended
durations of HCA and extracorporeal circulation often involved in
complex cardiac surgeries.1 Rezaei et al.estimate that acute kidney injury (AKI) occurs in up to 40% of FET
cases, while Bashir et al. reports a pooled estimate of 15.5%
(95% CI, 11.9-20.1) incidence.1, 5 Factors such as
advanced age, elevated preoperative serum creatinine, pre-existing
hypertension, intraoperative extracorporeal circulation ≥ 260 min, CPB
≥ 180 min, and implantation of a 4-branched Dacron graft with FET have
been shown to increase the risk of AKI following FET arch
repair.27, 28 6% (n=6) of patients in Yamamoto and
colleague’s report suffered AKI and required dialysis following Z-0-FET,
while Jakob et al. noted a permanent renal failure and AKI
incidence rates of 16.7%.16, 17 50% (n=3) of
patients in Jakob and colleague’s trial required haemodiafiltration
postoperatively.17 In contrast, the incidence of
postoperative haemodiafiltration following Z-2-FET has been shown to
vary between 22% and 32%, and indeed Beckmann et al.highlighted 8% (n=8) of their patients suffered permanent kidney
failure following Z-2-FET repair.12, 13, 22 It would
be reasonable to suggest that that lower incidence of AKI and renal
failure in Yamamoto and colleague’s report could be due to the shorter
duration of CPB and extracorporeal circulation associated with
proximalised aortic arch repair, yet one should recall that there has
yet to be any large, multi-centre studies examining postoperative
outcomes from Z-0-FET.27