S. M. Mitchell1, C. Mavroudis1, P. Amin1, J. Frazier1, M. Bakhos1, K. Sawicki1, P. Carmignani1, J. Schwartz1 1Loyola University Chicago Stritch School Of Medicine,Department Of Thoracic And Cardiovascular Surgery,Maywood, IL, USA
Introduction: Acute kidney injury is a significant complication of open thoracoabdominal aortic aneurysm repair and a substantial number of patients go on to need hemodialysis. Various perfusion strategies for renal protection as well as endovascular repair have been used with differing degrees of success. Currently, the ideal method of renal protection is controversial. The purpose of this research was to evaluate the perfusion strategy used at our center with regards to acute kidney injury and post-operative hemodialysis requirement as compared to alternative techniques used at other institutions.
Methods: A retrospective review of 71 patients undergoing open thoracoabdominal aortic aneurysm repair at Loyola University Medical Center between 2002 and 2013 was performed. Effectiveness of intraoperative cold blood perfusion as a renal protection strategy was evaluated by specifically looking at post-operative creatinine trends and need for hemodialysis and comparing our results to those of other institutions. Additional information collected included demographics, cross-clamp time, pump time, visceral perfusion time, and extent of aneurysm.
Results: Acute kidney injury was seen in 18.3% of patients post-operatively, with 5.6% requiring dialysis, and 1.4% being discharged on dialysis. Statistical analysis demonstrated a significant difference between pre-operative and peak creatinine levels, yet not between pre-operative and discharge, 6 month, and 1 year follow-up creatinine levels.
Conclusion: Despite advances in perfusion and surgical technique, acute kidney injury remains a serious complication of thoracoabdominal aortic aneurysm repair. In this study, a statistically significant rise in creatinine was seen post-operatively, however no significant difference was seen between pre-operative and discharge creatinine levels. When compared to benchmark outcomes for open repair, we had a higher incidence of acute kidney injury, however a lower percentage of patients requiring hemodialysis post-operatively. Our low rate of post-operative dialysis requirements compared to other centers and lack of significant difference between pre-operative and discharge creatinine shows that our perfusion technique, continuous cold blood visceral perfusion, is an excellent reno-protective technique compared to others used in open as well as endovascular repair.