Visceral and Renal Tissue Oxygenation During Supraceliac Aortic Crossclamping and Left Heart Bypass with Selective Organ Perfusion

Abstract

Introduction. Left-heart bypass (LHB) and selective organ perfusion (SOP) are used during thoracoabdominal aortic surgery to prevent ischemic damage to the kidneys and visceral organs after supraceliac aortic crossclamping. We studied the hypothesis, in a porcine model, that despite LHB and maximal SOP, visceral and renal ischemia still occured during surgery.Material and methods. Eleven pigs (54–70 kg) were coupled to a non-pulsatile LHB with inflow and outflow at the lower thoracic and distal infrarenal aorta, respectively. After supracoeliac and infrarenal aortic crossclamping, SOP was started using perfusion catheters. The proximal and distal mean aortic blood pressures were kept above 70 and 50 mmHg, respectively, while the mean blood pressure within the SOP system was above 60 mmHg. The visceral and renal tissue oxygenation was measured by intermittent blood gas analysis, from the portal and both renal veins. The jejunal mucosal oxygenation was measured by tonometric measurement of the luminal pCO2.Results. Measured median blood blood flow through the LHB and the SOP system were 800 and 1140 ml/min, respectively. Median blood flow prior to, and during LHB and SOP through the celiac artery, superior mesenteric artery, and left renal artery were 300 and 240, 762 and 295, and 235 and 235 ml/min, respectively. During 3 h of LHB and SOP no significant changes in the renal tissue oxygenation were noted compared with the physiological situation prior to supracoeliac aortic crossclamping and cannulation. However, in the visceral vascular bed median mixed venous oxygen saturation dropped from 79 to 63% (p<0.001), and median oxygen extraction ratio increased from 26 to 41% (p<0.001). Median tonometric measured intraluminal jejunal pCO2 increased from 9.9 to 12.15kPa (p>0.05). During 3 h of LHB and SOP no hemolysis was detected, as there was no rise in serum LDH.Conclusion. LHB and SOP preserves renal but not visceral tissue oxygenation during supraceliac aortic crossclamping and does not induce hemolysis.