Renal perfusion during thoracoabdominal aortic operations: cold crystalloid is superior to normothermic blood.
BACKGROUND
Renal failure remains a common complication of thoracoabdominal aortic aneurysm repair. The purpose of this randomized clinical trial was to compare two methods of selective renal perfusion--cold crystalloid perfusion versus normothermic blood perfusion--and determine which technique provides the best kidney protection during thoracoabdominal aortic aneurysm repair.


METHODS
Thirty randomized patients undergoing Crawford extent II thoracoabdominal aortic aneurysm repair with left heart bypass had renal artery perfusion with either 4 degrees C Ringer's lactate 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 experienced renal failure requiring hemodialysis. Ten patients (63%) in the blood perfusion group and 3 patients (21%) in the cold crystalloid perfusion group experienced 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 left heart bypass during repair of extensive thoracoabdominal aortic aneurysms, selective cold crystalloid perfusion offers superior renal protection when compared with conventional normothermic blood perfusion.
Köksoy
Cüneyt
C
The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, and The Methodist Hospital, Houston 77030, Texas, USA.
LeMaire
Scott A
SA
Curling
Patrick E
PE
Raskin
Steven A
SA
Schmittling
Zachary C
ZC
Conklin
Lori D
LD
Coselli
Joseph S
JS
D000368:Aged; D002314:Cardioplegic Solutions / Q000627:therapeutic use*; D005260:Female; D018611:Heart Bypass, Left / Q000379:methods*; D006801:Humans; D007511:Ischemia / Q000517:prevention & control; D007668:Kidney / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D017680:Potassium Compounds / Q000627:therapeutic use*; D014781:Viscera / Q000098:blood supply
D002314:Cardioplegic Solutions; D017680:Potassium Compounds; C018369:potassium cardioplegic solution