Prevention of renal failure in patients undergoing thoracoabdominal aortic aneurysm repair

Abstract

Objective: Renal failure is a potential complication after thoracoabdominal aortic aneurysm (TAAA) repair and is a significant risk factor for postoperative mortality. We assessed the results of distal aortic perfusion and continuous volume-controlled and pressure-controlled blood perfusion of the kidneys during TAAA repair in patients with preoperative normal and impaired renal function.

Methods: Surgical repair of TAAA was performed in 279 consecutive patients (type I, n = 90; type II, 117; type III, 42; type IV, 30). In 195 patients preoperative renal function was normal; however, in 84 patients renal insufficiency was diagnosed (serum creatinine concentration [SCr], 1.4-2.0 mg/dL, n = 46; SCr, 2.0-2.5 mg/dL, n = 20; and SCr, >2.5 mg/dL, n = 18). Renal perfusion was established with catheters connected to the left-sided heart bypass. Volume flow was assessed with ultrasound, and pressure channels in the catheters enabled pressure- controlled perfusion of the kidneys.

Results: Selective renal artery perfusion was achieved in all patients without technical problems or complications. In each catheter, mean arterial pressure was 69 mm Hg and volume flow was 275 mL/min. During aortic cross-clamping, urine output was uninterrupted, irrespective of clamp time. Most patients demonstrated limited or moderate increase in SCr concentration. In 17 patients (6%) SCr doubled, and peaked above 3 mg/dL, but returned to baseline levels within several days. Three patients (1%) required temporary dialysis but were discharged without further need for dialysis. In general, preoperative renal impairment did not worsen.

Conclusion: Distal aortic and selective renal blood perfusion is an effective measure to protect renal function during TAAA repair, but only if perfusion is provided with adequate volume and pressure. This technique also averts dialysis in most patients with preoperative renal failure.