Techniques and Strategies for Renal Protection in the Open Surgery of Pararenal Aneurysms

Abstract

Objectives: To determine if renal perfusion with a cold crystalloid solution enriched with histidine-tryptophanketoglurarate (Custodiol, Dr. Franz-Kohler Chemie GmbH, Bensheim, Germany) offers a better protection against renal ischemic lesions compared to cold Ringer lactate in patients treated by open surgery for a pararenal aortic aneurysms (PAA). Materials and Methods: We studied 256 consecutive patients treated by open surgery for PAA between 1993 and 2013. In181cases thedirect perfusionof at least one renal artery was carried out. Among these patients, 87 had renal perfusion with Ringer lactate solution and 94 with a Custodiol solution. A score of propensity, based on clinical variables which would probably have influenced the renal function, was carried out to correct skews which could be associated with the use of Custodiol. Acute postoperative renal failure (ARF)was stratified in five classes according to the postoperative serum creatinine values and the need for dialysis, and wascompared in the twogroups, and the independent predictive factors ofARFwere identifiedwith amultivariate analysis. Results: After the score of propensity we could compare 74 patients perfused with Custodiol with those receiving a Ringer lactate perfusion. Overall mortality at 30 days was 3.4%,with a need for temporary hemodialysis or continuous venovenous hemofiltration in 4.7% of cases, and dialysis at discharge in 2.7% of the cases. Absence of ARF > 2 (> 100% rise in the baseline level of creatinine) and the need for dialysis were significantly better in the Custodiol group (P1⁄4.007; and P1⁄4.04, respectively). With the multivariate analysis the Custodiol perfusion and the duration of clamping were the predictive factors independent of non-IRA> 2. Conclusion: In our series of PAA repair, renal perfusion with 4 C Custodiol offers a better renal protection compared to Ringer lactate at 4 C. More series and/or randomized trials are necessary to confirm this conclusion.