Comparison of renal perfusion solutions during thoracoabdominal aortic aneurysm repair

Tshomba, Yamume; Kahlberg, Andrea; Melissano, Germano; Coppi, Giovanni; Marone, Enrico Maria; Ferrari, Denise; Lembo, Rosalba; Chiesa, Roberto

doi:10.1016/j.jvs.2013.09.055

Cited by 63 publications

(40 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Larger comparative series, randomized trials, and the use of new biomarkers able to detect even subclinical renal injury together with continuous evaluation of new substrates are needed for an incessant renal outcomes improvement. [22]…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Renal Perfusion During Aortic Surgery: Looking for the Ideal Substrate

Tshomba

Simonini

Colombo

et al. 2019

Visceral Vessels and Aortic Repair

Self Cite

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

“…In 2014, Tshomba and Chiesa reported a retrospective comparative study to assess effectiveness in renal protection of Custodiol when compared with lactated Ringer's solution [22].…”

Section: Custodiol Solutionmentioning

confidence: 99%

Renal Perfusion During Aortic Surgery: Looking for the Ideal Substrate

Tshomba

Simonini

Colombo

et al. 2019

Visceral Vessels and Aortic Repair

Self Cite

View full text Add to dashboard Cite

“…S43 A subsequent randomised controlled trial showed that cold blood perfusion does not enhance renal protection compared with cold crystalloid perfusion 31. A recent study from the Chiesa group has shown that cold crystalloid solution enriched with histidine-tryptophan-ketoglutarate (Custodiol; Dr Franz-Kohler Chemie GmbH, Bensheim, Germany) is safe and has the potential to provide better protection against ischaemic renal injury than lactated Ringer’s solution 32. The most recent guidelines recommend considering the use of either cold crystalloid or blood perfusion for renal protection (class IIb, level of evidence B) (table 5).…”

Section: Recent Therapeutic Developments That Have Improved Outcomesmentioning

confidence: 99%

Surgical management of thoracoabdominal aneurysms

Ziganshin

Elefteriades

2014

Heart

View full text Add to dashboard Cite

Thoracoabdominal aneurysm of the aorta (TAAA) is a morbid condition, the treatment of which can be associated with high mortality and complication rates, as well as prolonged length of hospital stay. Currently, three approaches to treatment of TAAAs exist: open, endovascular and hybrid repair. Over the past three decades, a significant decrease in postoperative mortality and paraplegia rates has been achieved due to effective application of such treatment adjuncts as left heart bypass, cerebrospinal fluid drainage, application of hypothermia and neuromonitoring, thereby making surgical treatment of TAAAs increasingly safer for the patient. In this report, we review indications and current approaches to surgical management of TAAAs, as well as the factors that influence the efficacy of this type of treatment.

show abstract

“…Visceral hematic perfusion is maintained by the pump with irrigation-occlusion catheters introduced selectively into the celiac trunk and the superior mesenteric artery. Selective cold perfusion of renal arteries is performed: initially a crystalloid solution with mannitol and steroids at 4 °C was used; however, following evidence of improved kidney preservation by perfusion with Custodiol (histidine-tryptophane-ketoglutarate), 5 we recently introduced routine use of this solution in our patients.…”

mentioning

confidence: 99%

“…15 Moreover, in recent years in high volume centers, technical adjuncts for renal protection have reduced the incidence of renal failure following open TAAA repair. 5 Thanks to technical improvements, open surgical repair of TAAA, is currently the gold standard in fit patients. Patient selection must be based on careful preoperative assessment and risk evaluation.…”

mentioning

confidence: 99%

Reparo aberto de aneurisma de aorta toracoabdominal: atualização da abordagem multimodal

2017

Self Cite

View full text Add to dashboard Cite

Open surgical repair of thoracoabdominal aortic aneurysms (TAAA) has evolved significantly over the last decades thanks to technical improvements, especially in the area of organ protection. However, despite adjunctive strategies, morbidity and mortality rates are still not negligible.In order to plan the best possible treatment modality for every patient, accurate imaging must be obtained and processed. The preferred imaging method is multidetector computed tomography (CT) scan. As well as defining diameters and extension of the pathology, analysis of vessels includes characteristics of calcification and thrombus, possible anatomic variations, and patency of vessels. At present, aortic diameter is the best criterion for predicting the risk of aortic rupture 1 and patients with TAAA can be considered for elective surgery if the aortic diameter exceeds 6.0 cm, or less in case of patients with chronic dissection or a connective tissue disorder.As the number of elderly people in the population has increased, so has the number of patients with TAAA associated with comorbidities. An adequate pre-operative assessment of cardiac, pulmonary, and renal function and an accurate knowledge of cerebral and spinal cord vascular anatomy are useful when evaluating operative risk and planning the best operative strategy.Pre-operative trans-thoracic echocardiography is a satisfactory noninvasive screening method that evaluates both valvular and biventricular function. Computed tomographic coronary angiography has emerged as a less-invasive method for assessing coronary artery disease and is routinely performed in patients with asymptomatic TAAA. In case of severe coronary artery disease, a coronary angiography is then performed and significant lesions are treated with percutaneous transluminal angioplasty prior to aneurysm repair, possibly avoiding the use of drug-eluting stents that would require prolonged double antiplatelet therapy. Surgical myocardial revascularization is limited to selected patients with severe high-risk coronary lesions that are not suitable for percutaneous transluminal angioplasty.Renal function is an established predictor of postoperative outcome. Based on eGFR assessment, chronic kidney disease has been shown to be a strong predictor of death after thoracic aneurysm repair for both open and endovascular procedures, even in patients without clinical evidence of preoperative renal disease. 2Evaluation of pulmonary function with arterial blood gases and spirometry is performed for all patients undergoing open TAAA repair.A CT brain scan and neuropsychological evaluation are performed in the elective setting. Anatomical anomalies or cerebral diseases that may contraindicate the use of Cerebrospinal fluid (CSF) drainage should be identified.Surgical strategy is preoperatively explained to any elective patient and informed consent is obtained.With regard to surgical strategy, the patient is positioned in a right lateral decubitus over a beanbag with the shoulders at 60° and the hips flexed back to 30° to acce...

show abstract

Comparison of renal perfusion solutions during thoracoabdominal aortic aneurysm repair

Abstract: The use of Custodiol was safe and provided improved perioperative renal function compared with lactated Ringer's solution. Randomized trials are needed to confirm these data and to assess their clinical consequences.

Cited by 63 publications

References 38 publications

Renal Perfusion During Aortic Surgery: Looking for the Ideal Substrate

Renal Perfusion During Aortic Surgery: Looking for the Ideal Substrate

Surgical management of thoracoabdominal aneurysms

Reparo aberto de aneurisma de aorta toracoabdominal: atualização da abordagem multimodal

Contact Info

Product

Resources

About