HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Scott A. LeMaire Joseph S. Coselli Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Köksoy, C. Articles by Coselli, J. S. Search for Related Content PubMed PubMed Citation Articles by Köksoy, C. Articles by Coselli, J. S. Related Collections Great vessels

Ann Thorac Surg 2002;73:730-738
© 2002 The Society of Thoracic Surgeons

---

Original article: cardiovascular

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

^a The Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Surgery, Baylor College of Medicine, and The Methodist Hospital, Houston, Texas, USA

* Address reprint requests to Dr Coselli, The Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Surgery, Baylor College of Medicine, The Methodist Hospital, 6560 Fannin, Suite 1100, Houston, TX 77030, USA
e-mail: jcoselli{at}bcm.tmc.edu

Presented at the Forty-seventh Annual Meeting of the Southern Thoracic Surgical Association, Marco Island, FL, Nov 9–11, 2000.

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°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.

This article has been cited by other articles:

				T. Kunihara, N. Shiiya, S. Wakasa, K. Matsuzaki, and Y. Matsui Assessment of hepatosplanchnic pathophysiology during thoracoabdominal aortic aneurysm repair using visceral perfusion and shunt Eur. J. Cardiothorac. Surg., April 1, 2009; 35(4): 677 - 683. [Abstract] [Full Text] [PDF]

				C. C. Miller III, M. A. Villa, P. Achouh, A. L. Estrera, A. Azizzadeh, S. M. Coogan, E. E. Porat, and H. J. Safi Intraoperative skeletal muscle ischemia contributes to risk of renal dysfunction following thoracoabdominal aortic repair Eur. J. Cardiothorac. Surg., April 1, 2008; 33(4): 691 - 694. [Abstract] [Full Text] [PDF]

				J. S. Coselli and S. A. LeMaire Descending and Thoracoabdominal Aortic Aneurysms Card. Surg. Adult, January 1, 2008; 3(2008): 1277 - 1298. [Full Text]

				J. S. Coselli, J. Bozinovski, and S. A. LeMaire Open Surgical Repair of 2286 Thoracoabdominal Aortic Aneurysms Ann. Thorac. Surg., February 1, 2007; 83(2): S862 - S864. [Abstract] [Full Text] [PDF]

				R. Erbel and H. Eggebrecht Aortic dimensions and the risk of dissection Heart, January 1, 2006; 92(1): 137 - 142. [Full Text] [PDF]

				R. G. MacArthur, S. A. Carter, J. S. Coselli, and S. A. LeMaire Organ Protection During Thoracoabdominal Aortic Surgery: Rationale for a Multimodality Approach Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2005; 9(2): 143 - 149. [Abstract] [PDF]

				L. N. Girardi, K. H. Krieger, C. A. Mack, L. Y. Lee, A. J. Tortolani, and O. W. Isom Does Cross-Clamping the Arch Increase the Risk of Descending Thoracic and Thoracoabdominal Aneurysm Repair? Ann. Thorac. Surg., January 1, 2005; 79(1): 133 - 137. [Abstract] [Full Text] [PDF]

				S. A. LeMaire, A. L. Jamison, S. A. Carter, S. Wen, S. Alankar, and J. S. Coselli Deployment of balloon expandable stents during open repair of thoracoabdominal aortic aneurysms: a new strategy for managing renal and mesenteric artery lesions Eur. J. Cardiothorac. Surg., September 1, 2004; 26(3): 599 - 607. [Abstract] [Full Text] [PDF]

				H. J. Safi, T. T. T. Huynh, H. T. Hassoun, C. C. Miller III, and A. L. Estrera Preventing Renal Failure in Thoracoabdominal Aortic Aneurysm Repair Perspectives in Vascular Surgery and Endovascular Therapy, March 1, 2004; 16(1): 3 - 11. [Abstract] [PDF]

				J. S. Coselli and P. L. Moreno Descending and Thoracoabdominal Aneurysm Card. Surg. Adult, January 1, 2003; 2(2003): 1169 - 1190. [Full Text]

				T. Fleck, C. Hamilton, M. P. Ehrlich, D. Hutschala, H. Koinig, E. Wolner, and M. Grabenwoger Thoracoabdominal Aortic Aneurysm Repair: Reducing Adverse Outcome with Left Heart Bypass, Selective Visceral Perfusion and Renal Protection Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2002; 6(4): 287 - 291. [Abstract] [PDF]

				J. S. Coselli, L. D. Conklin, and S. A. LeMaire Thoracoabdominal aortic aneurysm repair: review and update of current strategies Ann. Thorac. Surg., November 1, 2002; 74(5): S1881 - 1884. [Abstract] [Full Text] [PDF]