Randomized comparison of cold blood and cold crystalloid renal perfusion for renal protection during thoracoabdominal aortic aneurysm repair.
OBJECTIVE
More effective adjuncts are needed to reduce the incidence of acute renal injury after thoracoabdominal aortic aneurysm (TAAA) repair. The purpose of this randomized trial was to determine whether renal perfusion with cold blood provides better protection against renal ischemia than perfusion with cold crystalloid in patients undergoing TAAA repair with left heart bypass.


METHODS
One hundred seventy-two patients were enrolled. Strict inclusion criteria were used, including planned Crawford extent II or III TAAA repair with left heart bypass. The patients were randomly assigned to receive intermittent renal perfusion with either 4 degrees C lactated Ringer's solution (n = 86) or 4 degrees C blood (n = 86). Renal complications within 10 days of operation were stratified by renal dysfunction score (RDS). Postoperative changes in the levels of five urinary biomarkers-retinol binding protein, alpha-1 microglobulin, microalbumin, N-acetyl-beta-D-glucosaminidase, and intestinal alkaline phosphatase-were compared to assess potential differences in subclinical renal injury.


RESULTS
Although total ischemic times were longer in the cold blood group, unprotected ischemic times were similar between the two groups. Twenty-seven patients in the cold blood group (31%) and 21 patients in the cold crystalloid group (24%) had peak RDS >or=2 (serum creatinine >50% above baseline; P = .4). There were no differences between the cold blood and cold crystalloid groups in the incidence of early death (7/86 [8%] vs 5/86 [6%], respectively; P = .8) or renal failure requiring hemodialysis (3/86 [3%] in both groups). Changes in renal biomarker levels were also similar in the two groups. Spinal cord deficits developed in 5 patients in the cold blood group (6%); there were no such deficits in the cold crystalloid group (P = .06).


CONCLUSIONS
Cold renal perfusion during TAAA repair provides effective protection against renal injury. Using cold blood instead of cold crystalloid does not enhance renal protection.
Lemaire
Scott A
SA
Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Texas, USA. slemaire@bcm.edu
Jones
Marisa M
MM
Conklin
Lori D
LD
Carter
Stacey A
SA
Criddell
Monique D
MD
Wang
Xing Li
XL
Raskin
Steven A
SA
Coselli
Joseph S
JS
D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000503:physiopathology / Q000601:surgery*; D015415:Biomarkers / Q000652:urine; D002314:Cardioplegic Solutions / Q000627:therapeutic use*; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D018611:Heart Bypass, Left; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use*; D007668:Kidney / Q000098:blood supply*; D007674:Kidney Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D017680:Potassium Compounds / Q000627:therapeutic use*; D012079:Renal Circulation; D000077325:Ringer's Lactate; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
D015415:Biomarkers; D002314:Cardioplegic Solutions; D007552:Isotonic Solutions; D017680:Potassium Compounds; D000077325:Ringer's Lactate; C018369:potassium cardioplegic solution