Impact of core temperature management and postoperative continuous renal replacement therapy in extensive aortic arch repair for type A dissection

Introduction

Type A aortic dissection (TAAD) represents one of the most critical and complex cardiovascular emergencies, exhibiting substantially higher mortality and morbidity rates compared to other structural heart diseases (1,2). Over the past decade, significant advances in surgical techniques have led to substantial reductions in operative mortality (1,3), yet the incidence of postoperative complications remains considerable, with organ protection continuing to pose significant challenges (4,5).

The kidney, being highly sensitive to ischemia, is particularly vulnerable to postoperative acute kidney injury and may require continuous renal replacement therapy (CRRT). While this complication has garnered considerable attention from clinicians, the long-term prognosis of affected patients remains unclear (6-8). Temperature management during surgery represents a crucial factor contributing to renal ischemia. Recent EACTS/STS guidelines (9) have provided clear definitions for hypothermic circulatory arrest (HCA) temperature ranges in aortic surgery, recommending 24–28 ℃ for complex arch procedures. This recommendation has been validated by research from our center (10). However, the specific impact of temperature on renal function remains inadequately understood. Therefore, we conducted this long-term follow-up study to investigate whether different HCA temperature strategies influence postoperative CRRT requirements in ATAAD patients undergoing total arch replacement (TAR) with frozen elephant trunk (FET) procedure, and to evaluate prognostic differences between CRRT and non-CRRT patients. We present this article in accordance with the STROBE reporting checklist (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2026-1-0365/rc).

Methods

The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study protocol received approval from the Institutional Ethics Committee of Fuwai Hospital (No. 2023-2084). The retrospective review of medical records was approved with a waiver of written informed consent.

Study population and data collection

This investigation encompassed consecutive patients who underwent TAR with FET for TAAD at our tertiary referral center (Fuwai Hospital) between January 2010 and December 2018. Individuals with established dialysis dependence preoperatively were excluded from the analysis cohort. CRRT was initiated when patients developed any of the following postoperative conditions in accordance with KDIGO guideline-based criteria (11,12): severe hyperkalemia (serum potassium >6.5 mmol/L refractory to medical therapy), severe metabolic acidosis (pH <7.15 or HCO₃⁻ <12 mmol/L), diuretic-resistant fluid overload, progressive renal deterioration [serum creatinine >353.6 µmol/L (4 mg/dL)], or oliguria/anuria (urine output <0.3 mL/kg/h for >24 hours). A more proactive initiation strategy was applied in patients with concurrent multi-organ dysfunction, high infectious risk, or significant myoglobinemia. Based on the requirement for postoperative CRRT, patients were stratified into CRRT and non-CRRT groups.

Follow-up was conducted through a multifaceted approach incorporating structured clinical assessments during specialized outpatient consultations, standardized telephone interviews, and secure digital communication platforms.

Surgical techniques

The surgical approach universally involved complete median sternotomy. Right axillary artery cannulation was the standard approach for arterial access throughout the study period, facilitating unilateral antegrade cerebral perfusion (ACP) at 8–12 mL/kg/min once the target core temperature was achieved. Upon initiation of cardiopulmonary bypass (CPB), interventions addressing aortic root pathology were completed concomitantly with systemic cooling. The target core temperature for HCA was determined on an individualized basis, reflecting evolving institutional practice patterns and individual surgeon preferences with regard to anticipated circulatory arrest duration, procedural complexity, and patient-specific factors. Detailed TAR with FET at our center has been previously described (3). In brief, following distal anastomosis completion, lower body circulation was re-established via the dedicated branch of the tetrafurcate graft. Supra-aortic vessel reconstruction proceeded sequentially—left common carotid, left subclavian, then innominate artery—after which systemic rewarming began. The procedure concluded with proximal anastomosis between the graft and either the ascending aorta or the reconstructed aortic root.

Endpoints and definitions

Primary endpoints comprised operative mortality, long-term survival, and activities of daily living (ADL). Operative mortality was defined as death within 30 days postoperatively or during the index hospitalization (13). The core temperature during HCA was stratified into four temperature bands (9): deep hypothermia (DH) (≤20 ℃), low-moderate hypothermia (LMH) (20.1–24 ℃), high-moderate hypothermia (HMH) (24.1–28 ℃), and mild hypothermia (MH) (>28 ℃).

For surviving patients, functional status was assessed using a four-level ADL classification (10): complete dependence (Level 1); partial self-sufficiency requiring assistance (Level 2); complete self-care capability with limited exertional capacity (Level 3); and preserved physical work capacity (Level 4). Renal recovery was defined as the simultaneous fulfillment of the following criteria prior to hospital discharge: return of serum creatinine to within the normal reference range (male: 53–106 µmol/L; female: 44–97 µmol/L), urine output exceeding 400 mL/24h or entry into the polyuric phase, absence of circulatory fluid overload, serum electrolytes within normal limits, absence of metabolic acidosis, and successful discontinuation of renal replacement therapy. Chronic renal failure was defined as sustained abnormal serum creatinine levels for more than 70 days following surgery. Dissection anatomy and end-organ malperfusion were characterized according to the comprehensive type, entry, and malperfusion (TEM) classification (9). TEM-M1 denoted coronary artery malperfusion, TEM-M2 denoted supra-aortic artery malperfusion, and TEM-M3 denoted malperfusion of the spinal, visceral, renal, or lower-extremity arteries.

Statistical analysis

Continuous variables were tested for normality using the Kolmogorov–Smirnov test. Normally distributed variables were presented as mean with standard deviation, and between-group differences were assessed using Student’s t-test. Non-normally distributed variables were expressed as median with interquartile range and compared using the Mann-Whitney U test. Categorical variables were described as frequencies with percentages and compared using the Chi-squared test or Fisher’s exact test, as appropriate. Long-term survival was estimated using the Kaplan-Meier method, and differences between groups were compared using the log-rank test. The cumulative incidence of incomplete self-care (ADL ≤2) was analyzed using the Gray-Fine regression model, with death considered as a competing risk.

Univariable and multivariable logistic regression analyses were performed to identify risk factors associated with the postoperative CRRT. The interaction between core temperature and CPB time was assessed by including their product term in the multivariable model, and their relationship was visualized using predicted probability curves for postoperative CRRT. The overall significance of the temperature-by-CPB duration interaction was formally evaluated using a Likelihood Ratio Test comparing models with and without the interaction term. To avoid overfitting, multivariable models were constructed hierarchically with a parsimonious set of covariates, which were determined by combining univariable analysis results (P<0.05), prior literature, and clinical expertise. Model 1 included core temperature, age, and sex; Model 2 further incorporated selected preoperative variables; Model 3 further incorporated selected intraoperative variables; and Model 4 additionally included the interaction effect between core temperature and CPB time. To address confounding by indication, we additionally performed a sensitivity analysis using the matching weights (MW) method, a variant of IPTW optimized for multi-categorical exposures. Propensity scores for each temperature category were estimated via multinomial logistic regression incorporating all preoperative and intraoperative covariates with P<0.05 in univariable analysis. Covariate balance was assessed using standardized mean differences (SMD), with SMD <0.1 considered indicative of adequate balance. In the weighted cohort, multivariable conditional logistic regression was performed to re-examine both the main effects of temperature and the temperature-by-CPB duration interaction. Restricted cubic splines (RCS) were applied to formally test the linearity assumption for CPB time (P for non-linearity >0.05). The overall significance of the temperature-by-CPB duration interaction was confirmed via a likelihood ratio test (LRT, P=0.02).

All statistical analyses were performed using R software version 4.2.1 (R Foundation for Statistical Computing, Vienna, Austria). A two-tailed P value <0.05 indicated statistical significance.

Results

Baseline characteristics

As shown in Figure S1, a total of 1,283 patients who underwent TAR with FET procedure were included in this study. Among these, 123 patients (9.6%) required CRRT postoperatively. The baseline characteristics are summarized in Table 1. Patients in the CRRT group were significantly older than those in the non-CRRT group [49.57 (11.68) vs. 46.35 (10.18) years, P=0.001]. The CRRT group had a lower proportion of male patients (70.7% vs. 79.5%, P=0.03) and Marfan syndrome patients (4.9% vs. 11.1%, P=0.03). Regarding the TEM classification, patients in the CRRT group had a higher incidence of coronary malperfusion (TEM-M1) without symptoms (22.8% vs. 11.8%, P=0.002) and symptomatic malperfusion of spinal, visceral, renal, or iliac arteries (TEM-M3) (36.6% vs. 15.5%, P<0.001).

Table 2 demonstrates the detailed intraoperative characteristics of the patients. Notably, there was a significant difference in the distribution of core temperature management strategies between groups (P=0.03), with a higher proportion of DH (≤20 ℃) in the CRRT group (25.2% vs. 16.5%).

Early outcomes

As shown in Table 3, patients in the CRRT group exhibited significantly higher early mortality compared to the non-CRRT group (38.2% vs. 3.7%, P<0.001). The CRRT group also experienced higher rates of major postoperative complications, including re-exploration for bleeding (12.2% vs. 3.2%, P<0.001), paraplegia (11.4% vs. 1.8%, P<0.001), low cardiac output syndrome (27.6% vs. 2.2%, P<0.001), and pneumonia (57.7% vs. 14.9%, P<0.001).

Factors associated with postoperative CRRT

Univariable logistic regression analysis identified multiple factors associated with postoperative CRRT requirement (Table S1). Subsequently, multivariable logistic regression analyses were performed to identify independent risk factors associated with postoperative CRRT (Table S2). Notably, a significant interaction was observed between core temperature management and CPB time (P for interaction =0.02). After incorporating this interaction term into the final regression model (Table S3, Model 4), higher temperature groups demonstrated protective effects compared to DH (P for trend =0.001). Specifically, LMH [odds ratio (OR) 0.286, 95% confidence interval (CI): 0.111–0.737, P=0.01], HMH (OR 0.091, 95% CI: 0.020–0.420, P=0.002), and MH (OR 0.025, 95% CI: 0.003–0.224, P=0.001) all showed significant protective effects against CRRT requirement (detailed coefficients, confidence intervals, and P values for all main effects and interaction terms are comprehensively reported in Tables S2,S3). To visualize this interaction, Figure 1 displays the marginal predicted probability of CRRT across the full spectrum of CPB duration for each temperature category. The plot demonstrates that the protective association of higher core temperatures was most pronounced at shorter CPB durations and progressively attenuated as CPB duration increased, with confidence intervals widening substantially in the region of extremely prolonged CPB times. The overall temperature-by-CPB duration interaction was statistically significant as confirmed by a likelihood ratio test (P=0.02).

Figure 1 Marginal effects of core temperature strategy on CRRT risk across CPB durations. Predicted marginal probabilities of CRRT requirement are displayed across the continuous spectrum of CPB duration for each temperature category (mild hypothermia, low-moderate hypothermia, high-moderate hypothermia, and deep hypothermia), derived from multivariable logistic regression incorporating a restricted cubic spline for CPB time. Shaded areas represent 95% confidence intervals. Vertical dashed lines serve as visual guides indicating the region where confidence intervals progressively widen and the protective association of higher core temperatures begins to attenuate. The overall temperature-by-CPB duration interaction was statistically significant (likelihood ratio test, P=0.02). CPB, cardiopulmonary bypass; CRRT, continuous renal replacement therapy; DH, deep hypothermia; HMH, high-moderate hypothermia; LMH, low-moderate hypothermia; MH, mild hypothermia.

Long-term outcomes

There were no losses during the follow-up period, with a median time of 6.02 [4.21, 8.26] years. Long-term survival was significantly lower in the CRRT group compared to the non-CRRT group (log-rank: P<0.001, Figure 2A). Among the 76 CRRT survivors, 13 late deaths occurred (17.1%), with causes including stroke (N=2), myocardial infarction (N=1), multiple organ dysfunction syndrome (N=3), and non-cardiovascular causes (N=7) (Table S4).

Figure 2 Long-term outcomes analyses. (A) Kaplan-Meier curve and log-rank analysis for long-term survival of overall patients. (B) Long-term renal function status in patients who received CRRT. (C) Kaplan-Meier curve and log-rank analysis for long-term survival of CRRT patients based on core temperature grouping. CRRT, continuous renal replacement therapy; DH, deep hypothermia; HMH, high-moderate hypothermia; LMH, low-moderate hypothermia; MH, mild hypothermia.

Importantly, among the survivors in the CRRT group, the majority (51/63, 81.0%) recovered renal function without requiring further dialysis. As shown in Figure 2B, complete recovery from CRRT was observed in all patients from the DH and MH groups, while 8.7% of patients in the LMH group and 8.3% in the HMH group remained dialysis-dependent.

When comparing long-term survival among CRRT patients across different core temperature groups, no significant differences were observed (Figure 2C). Similarly, the quality of life, as measured by ADL, remained comparable between CRRT and non-CRRT groups (Fine-Gray: P=0.91, Figure 3A), with most surviving patients in both groups maintaining complete self-care ability (Figure 3B).

Figure 3 Functional outcomes analyses stratified by CRRT requirement. (A) Competing risk analysis for incomplete self-care and death. (B) Histogram showing long-term ADL grades. ADL, activities of daily living; CRRT, continuous renal replacement therapy.

Sensitivity analysis

To rigorously address this, we implemented the matching weights (MW) method—a robust extension of the inverse probability of treatment weighting (IPTW) framework specifically optimized for multi-categorical treatment exposures. Propensity scores were estimated for each of the four temperature categories (DH, LMH, HMH, MH) using multinomial logistic regression, incorporating all clinically relevant preoperative and intraoperative covariates including age, sex, coronary artery disease, chronic kidney disease, NYHA class, preoperative creatinine, CPB time, emergency status, and concomitant procedures (e.g., CABG). Covariate balance after weighting is demonstrated in the newly added Love plot (Figure S2), and the weighted cohort characteristics are summarized in Tables S5-S10, confirming substantially improved balance across all four temperature groups. Re-examining the Interaction in the Weighted Cohort—Conditional Logistic Regression: Using this propensity score-weighted cohort, we performed multivariable conditional logistic regression incorporating both the main temperature effects and the temperature-by-CPB duration interaction term. The results are presented in Table S11.

Discussion

This study evaluated the impact of different HCA temperatures on postoperative CRRT after extensive aortic arch repair for TAAD. We found that while higher temperatures were associated with reduced CRRT risk, this association was attenuated with longer CPB duration, suggesting the potential benefit of individualized temperature management strategies.

The incidence of acute kidney injury (AKI) following TAAD repair varies widely across the literature, ranging from 20% to 67%, with approximately 3–11% of patients ultimately requiring CRRT (14-17). This complication significantly compromises both short- and long-term survival. The kidney is highly sensitive to temperature fluctuations during CPB, yet considerable controversy persists regarding optimal temperature strategies for organ protection. Some investigators have argued for the continued use of DH (18,19). While mounting evidence suggests that the renal protective effects of DH may be limited. Abjigitova et al. (20) found no significant difference in renal injury or CRRT risk between deep and moderate hypothermia strategies. Similarly, Arnaoutakis et al. (21) analyzed 589 patients undergoing elective aortic hemiarch replacement and demonstrated that moderate hypothermia (mean 26.4 ℃) yielded comparable renal outcomes to DH (mean 17.5 ℃), while prolonged CPB time emerged as an independent predictor of postoperative AKI.

An increasing body of evidence supports the renal protective effects of moderate hypothermia. Cao et al. (4) demonstrated that moderate hypothermia reduces both renal injury incidence and postoperative CRRT requirements when HCA duration is ≤30 minutes. These findings align with our results, which demonstrated protective effects for all temperature groups (LMH, HMH, and MH) compared to DH (≤20 ℃). While CPB duration is influenced by multiple factors—including the fundamental relationship between temperature and required cooling/rewarming times—our study uniquely identified a critical interaction between temperature and CPB duration. Specifically, the protective effect of higher temperatures diminished with prolonged CPB time, and the trend may even reverse at extremely prolonged CPB durations. However, this observation should be interpreted cautiously, as CPB durations exceeding 600 minutes were exceedingly rare in our cohort, resulting in sparse data and substantially wider confidence intervals in this region. Accordingly, Figure 1 has been truncated at 600 minutes to focus on the clinically relevant CPB range, and the trend observed at extreme durations remains hypothesis-generating rather than conclusive.

This study provides the first comprehensive survival comparison between patients requiring postoperative CRRT and other patients undergoing TAR with FET. While the entire cohort achieved a satisfactory 10-year survival rate of 80%, the CRRT group demonstrated significantly reduced survival at 48%. Among the 63 long-term survivors in the CRRT group, functional outcomes were encouraging: only 4 patients required long-term dialysis at final follow-up, 8 patients achieved dialysis independence but maintained chronic renal insufficiency managed medically, and 51 patients experienced complete renal recovery. Several mechanisms may underlie these observations. First, both the dissection process and CPB trigger substantial inflammatory mediator release, leading to systemic inflammatory response syndrome. Second, hypothermia may cause heterogeneous renal perfusion disturbances and microcirculatory dysfunction. Additionally, the cooling and rewarming phases of CPB induce ischemia-reperfusion injury, exacerbating local hypoxia and tubular damage. These insults are largely transient; as hemodynamic stability is restored, renal oxygen balance is reestablished and tubular regeneration can occur. Importantly, despite higher early mortality, temperature strategy did not influence long-term survival among CRRT patients who survived to discharge. Moreover, successfully discharged CRRT patients achieved comparable quality of life and reoperation rates to their counterparts—a finding of considerable clinical significance. It should be acknowledged, however, that the long-term survival comparison among CRRT patients across temperature groups (Figure 2C) was limited by the small sample size in the MH group (n=7 at baseline), and thus serves primarily as a descriptive, hypothesis-generating observation rather than a robust statistical conclusion.

Our analysis identified advanced age, preoperative coronary artery disease, and elevated baseline creatinine as independent risk factors for CRRT, findings that are consistent with reports from other centers (22-24). Jiao et al. (22) similarly identified age >65 years and preexisting renal dysfunction as independent predictors of postoperative CRRT. Elderly patients possess limited preoperative renal reserve, and when subjected to the additional stressors of surgical intervention, CPB, and hemodynamic perturbations, their renal function readily decompensates, necessitating CRRT support. Gender differences in aortic dissection outcomes remain controversial. Our previous analysis of 1,672 patients showed female gender increased operative and long-term mortality risk (3), while Norton et al. (25) found it protective for operative mortality. In our current study, female gender consistently emerged as an independent risk factor for CRRT—a novel finding warranting increased clinical attention.

Limitations

This study has several limitations. As a retrospective analysis, findings are subject to selection bias and unmeasured confounding, limiting causal inference. Temperature selection was not randomized but reflected evolving institutional practices and surgeon preferences during the study period. This non-standardized approach may have introduced unmeasured confounders related to case complexity, surgical timing, or patient-specific factors that influenced both temperature choice and outcomes. Our patient population is younger than Western cohorts and undergoes more extensive arch reconstruction—TAR with FET, which may limit generalizability but enables valuable long-term outcome assessment through extended follow-up protocols. Additionally, the analysis of patients with extremely prolonged CPB durations is limited by sparse data, resulting in wider confidence intervals in this subgroup; therefore, the observed trend of diminishing protective effects at prolonged CPB times warrants cautious interpretation and requires validation in larger cohorts. Furthermore, although CRRT initiation at our center followed standardized, protocol-driven criteria consistent with established international guidelines, center-specific intensive care unit (ICU) practices and decision-making thresholds may vary across institutions, which could affect the generalizability of CRRT as a study endpoint to other centers.

Conclusions

In conclusion, the findings of this large observational cohort suggest that higher core temperatures may be associated with reduced CRRT risk during TAR with FET procedure, though this association appears to be modified by CPB duration. Given the retrospective, single-center design of this study, these results should be considered hypothesis-generating rather than prescriptive. Prospective studies or randomized controlled trials are needed to validate these findings and to establish definitive temperature management recommendations, particularly for complex cases with prolonged CPB duration.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://jtd.amegroups.com/article/view/10.21037/jtd-2026-1-0365/rc

Data Sharing Statement: Available at https://jtd.amegroups.com/article/view/10.21037/jtd-2026-1-0365/dss

Peer Review File: Available at https://jtd.amegroups.com/article/view/10.21037/jtd-2026-1-0365/prf

Funding: This study was supported by the National Natural Science Foundation of China (No. 82400565) and the CAMS Innovation Fund for Medical Sciences (CIFMS) (2022-I2M-C&T-B-039).

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2026-1-0365/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. This study received approval from the Ethics Committee of Fuwai Hospital, Beijing, China, on August 20, 2023 (No. 2023-2084). The requirement for written informed consent was waived given its retrospective nature.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Evangelista A, Isselbacher EM, Bossone E, et al. Insights From the International Registry of Acute Aortic Dissection: A 20-Year Experience of Collaborative Clinical Research. Circulation 2018;137:1846-60. [Crossref] [PubMed]
2. Carrel T, Sundt TM 3rd, von Kodolitsch Y, et al. Acute aortic dissection. Lancet 2023;401:773-88. [Crossref] [PubMed]
3. Zhang K, Qiu J, Wu J, et al. Long-term outcomes in total arch replacement combined with frozen elephant trunk for acute type A aortic dissection. J Thorac Cardiovasc Surg 2025;170:994-1005.e9. [Crossref] [PubMed]
4. Cao L, Guo X, Jia Y, et al. Effect of Deep Hypothermic Circulatory Arrest Versus Moderate Hypothermic Circulatory Arrest in Aortic Arch Surgery on Postoperative Renal Function: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2020;9:e017939. [Crossref] [PubMed]
5. Fang Z, Wang G, Liu Q, et al. Moderate and deep hypothermic circulatory arrest has a comparable effect on acute kidney injury after total arch replacement with frozen elephant trunk procedure in type A aortic dissection. Interact Cardiovasc Thorac Surg 2019;29:130-6. [Crossref] [PubMed]
6. Norton EL, Longi FN, Wu X, et al. Renal Dysfunction at Discharge and Long-Term Survival in Acute Type A Aortic Dissection. J Surg Res 2024;296:472-80. [Crossref] [PubMed]
7. Samanidis G, Kanakis M, Kourelis G, et al. Acute renal failure after acute type A aortic dissection repair. Insidious postoperative complication with poor short- and long-term prognosis. J Card Surg 2022;37:2618-20.
8. Wang Z, Ge M, Chen T, et al. Independent risk factors and the long-term outcomes for postoperative continuous renal replacement treatment in patients who underwent emergency surgery for type a acute aortic dissection. J Cardiothorac Surg 2020;15:100. [Crossref] [PubMed]
9. Authors/Task Force Members. EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ. Ann Thorac Surg 2024;118:5-115.
10. Zhang K, Zhou C, Gao S, et al. The optimal degree of core temperature for hypothermic circulatory arrest in complex aortic arch surgery: results from 1310 patients. Eur J Cardiothorac Surg 2024;66:ezae311. [Crossref] [PubMed]
11. STARRT-AKI Investigators. Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury. N Engl J Med 2020;383:240-51.
12. Pérez-Fernández X, Ulsamer A, Cámara-Rosell M, et al. Extracorporeal Blood Purification and Acute Kidney Injury in Cardiac Surgery: The SIRAKI02 Randomized Clinical Trial. JAMA 2024;332:1446-54. [Crossref] [PubMed]
13. Maximus S, Milliken JC, Danielsen B, et al. Defining operative mortality: Impact on outcome reporting. J Thorac Cardiovasc Surg 2016;151:1101-7. [Crossref] [PubMed]
14. Arnaoutakis GJ, Ogami T, Patel HJ, et al. Acute Kidney Injury in Patients Undergoing Surgery for Type A Acute Aortic Dissection. Ann Thorac Surg 2023;115:879-85. [Crossref] [PubMed]
15. Roh GU, Lee JW, Nam SB, et al. Incidence and risk factors of acute kidney injury after thoracic aortic surgery for acute dissection. Ann Thorac Surg 2012;94:766-71. [Crossref] [PubMed]
16. Wang Z, Ge M, Wang Z, et al. Identification of risk factors for postoperative stage 3 acute kidney injury in patients who received surgical repair for acute type A aortic dissection. BMC Surg 2022;22:75. [Crossref] [PubMed]
17. Kowalik MM, Lango R, Klajbor K, et al. Incidence- and mortality-related risk factors of acute kidney injury requiring hemofiltration treatment in patients undergoing cardiac surgery: a single-center 6-year experience. J Cardiothorac Vasc Anesth 2011;25:619-24. [Crossref] [PubMed]
18. Kozlov BN, Panfilov DS, Kim EB. Long-term outcomes of frozen elephant trunk for aortic dissection: a single-center experience. J Cardiothorac Surg 2024;19:559. [Crossref] [PubMed]
19. Englum BR, Andersen ND, Husain AM, et al. Degree of hypothermia in aortic arch surgery - optimal temperature for cerebral and spinal protection: deep hypothermia remains the gold standard in the absence of randomized data. Ann Cardiothorac Surg 2013;2:184-93. [Crossref] [PubMed]
20. Abjigitova D, Notenboom ML, Veen KM, et al. Optimal temperature management in aortic arch surgery: A systematic review and network meta-analysis. J Card Surg 2022;37:5379-87. [Crossref] [PubMed]
21. Arnaoutakis GJ, Vallabhajosyula P, Bavaria JE, et al. The Impact of Deep Versus Moderate Hypothermia on Postoperative Kidney Function After Elective Aortic Hemiarch Repair. Ann Thorac Surg 2016;102:1313-21. [Crossref] [PubMed]
22. Jiao R, Lu XR, Ding H, et al. Prognosis factors for death within 90 days of discharge in patients with acute kidney injury requiring continuous renal replacement therapy after surgery for Stanford type A acute aortic dissection. Zhonghua Wai Ke Za Zhi 2022;60:466-71. [Crossref] [PubMed]
23. Chen X, Zhou J, Fang M, et al. Incidence- and In-hospital Mortality-Related Risk Factors of Acute Kidney Injury Requiring Continuous Renal Replacement Therapy in Patients Undergoing Surgery for Acute Type a Aortic Dissection. Front Cardiovasc Med 2021;8:749592. [Crossref] [PubMed]
24. Chen X, Bai M, Sun S, et al. Risk factors of mortality in AAAD patients who had severe postoperative hyperbilirubinemia and received CRRT. J Card Surg 2021;36:1320-7. [Crossref] [PubMed]
25. Norton EL, Kim KM, Fukuhara S, et al. Differences among sexes in presentation and outcomes in acute type A aortic dissection repair. J Thorac Cardiovasc Surg 2023;165:972-81. [Crossref] [PubMed]