Renal perfusion during thoracoabdominal aortic surgery: cold crystalloid is superior to normothermic blood

Abstract

Introduction. Renal failure remains a significant and potentially lethal complication after thoracoabdominal aortic aneurysm (TAAA) repair, ranging from 7% to 40% in recent series. The purpose of this randomized trial was to compare two methods of selective renal perfusion (cold crystalloid vs normothermic blood) during TAAA repair.Methods. Thirty randomized patients undergoing TAAA repair with left heart bypass (LHB) had renal artery perfusion with either 4°C lactated Ringer’s solution (14 patients) or normothermic blood from the bypass circuit (16 patients). Acute renal dysfunction was defined as an elevation in serum creatinine level exceeding 50% of baseline within 10 postoperative days.Results. One death occurred in each group. One patient in the blood perfusion group developed kidney failure requiring hemodialysis. Ten patients (63%) in the blood perfusion group and 3 patients (21%) in the cold crystalloid perfusion group developed acute renal dysfunction (p = 0.03). Multivariable analysis confirmed that the use of cold crystalloid perfusion was independently protective against acute renal dysfunction (p = 0.02, odds ratio 0.133).Conclusions. When using LHB during repair of extensive TAAAs, selective cold crystalloid perfusion offers superior renal protection when compared with normothermic blood perfusion. Introduction. Renal failure remains a significant and potentially lethal complication after thoracoabdominal aortic aneurysm (TAAA) repair, ranging from 7% to 40% in recent series. The purpose of this randomized trial was to compare two methods of selective renal perfusion (cold crystalloid vs normothermic blood) during TAAA repair. Methods. Thirty randomized patients undergoing TAAA repair with left heart bypass (LHB) had renal artery perfusion with either 4°C lactated Ringer’s solution (14 patients) or normothermic blood from the bypass circuit (16 patients). Acute renal dysfunction was defined as an elevation in serum creatinine level exceeding 50% of baseline within 10 postoperative days. Results. One death occurred in each group. One patient in the blood perfusion group developed kidney failure requiring hemodialysis. Ten patients (63%) in the blood perfusion group and 3 patients (21%) in the cold crystalloid perfusion group developed acute renal dysfunction (p = 0.03). Multivariable analysis confirmed that the use of cold crystalloid perfusion was independently protective against acute renal dysfunction (p = 0.02, odds ratio 0.133). Conclusions. When using LHB during repair of extensive TAAAs, selective cold crystalloid perfusion offers superior renal protection when compared with normothermic blood perfusion.