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Cold Blood and Cold Crystalloid Renal Perfusion Afford Similar Protection Against Acute Renal Injury During Thoracoabdominal Aortic Aneurysm Repair: Results of a Randomized Trial

Joseph S. Coselli, Marisa M. Jones, Stacey A. Carter, Lori D. Conklin, Monique D. Criddell, Xing Li Wang, Scott A. LeMaire.
Texas Heart Institute at St. Luke's Episcopal Hospital and Baylor College of Medicine, Houston, Texas.

OBJECTIVES: More effective adjuncts are needed to reduce the incidence of acute renal dysfunction 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.
 
METHODS: One hundred and seventy-two patients with TAAAs were enrolled. Strict inclusion criteria were used, including planned Crawford extent II or III TAAA repair with left heart bypass, unruptured aneurysm, and normal preoperative renal function. The patients were randomly assigned to receive intermittent renal perfusion with either 4ºC lactated Ringer’s solution (86 patients) or 4ºC blood (86 patients). Acute renal dysfunction was defined as a Renal Dysfunction Score of 3 or more (ie, serum creatinine >100% above baseline) within 10 days of surgery. Peak postoperative levels of 5 urinary biomarkers - retinol binding protein (RBP), α-1 microglobulin, microalbumin, N-acetyl-β-D-glucosaminidase (NAG), and intestinal alkaline phosphatase (IAP) - were compared to assess potential differences in subclinical renal injury. Fisher exact tests were used for categorical data, and Wilcoxon Rank-Sum tests were used for biomarker levels.

RESULTS: The overall early mortality rate was 6% (11/172), and paraplegia or paraparesis developed in 3% of patients (5/172). There were no differences between the 2 groups in the incidence of early death, renal dysfunction, or renal failure requiring hemodialysis [Table 1]. Peak renal injury biomarker levels were also similar.

CONCLUSIONS: Cold renal perfusion during TAAA repair effectively protects patients against renal dysfunction. Using cold blood instead of cold crystalloid does not enhance renal protection.
AUTHOR DISCLOSURES: J.S. Coselli, None; M.M. Jones, None; S.A. Carter, None; L.D. Conklin, None; M.D. Criddell, None; X. Wang, None; S.A. LeMaire, None.