Renal perfusion with histidine-tryptophan-ketoglutarate compared with Ringer's solution in patients undergoing thoracoabdominal aortic open repair

Kahlberg, Andrea; Tshomba, Yamume; Baccellieri, Domenico; Bertoglio, Luca; Rinaldi, Enrico; Ardita, Vincenzo; Colombo, Emilio; Moscato, Umberto; Melissano, Germano; Chiesa, Roberto; Apruzzi, Luca; Bossi, S.; Castellano, Renata; Catenaccio, Barbara; Ferrante, Angela Maria Rosaria; Landoni, Giovanni; Lembo, Rosalba; Nardelli, Pasquale; Pasin, Laura; Simonini, Elisa; Venturini, Massimo

doi:10.1016/j.jtcvs.2021.02.090

Cited by 26 publications

(9 citation statements)

References 23 publications

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“…15 A randomized double-blind trial comparing Custodiol HTK solution to conventional crystalloid solution showed that Custodiol HTK solution was an independent predictor of decreased AKI rates. 41 Small trials comparing renal perfusion with blood versus conventional crystalloid CRP showed inferiority of normothermic blood perfusion and similar efficacy of cold Ringer solution and cold blood. 17,42 Regarding the optimal temperature of CRP, Svensson and colleagues 31 monitored renal temperature during CRP with cooling to a mean of 17.2°C in a subset of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative renal insufficiency was defined as a normal preoperative creatinine level (< 1.8 mg/dL [159.12 μmol/L]) increasing to an abnormal level (> 1.8 mg/dL [159.12 μmol/L]) or an increase in serum creatinine greater than 20% by Allen and colleagues, 24 as an increase in serum creatinine level greater than 50% by Anagnostopoulos and colleagues, 30 as a doubling of the serum creatinine level to more than 3.0 mg/dL (265.2 μmol/L) or a requirement of dialysis by Kashyap and colleagues, 40 as a serum creatinine level greater than 2 mg/dL (176.8 μmol/L) by Svensson and colleagues, 31 and as an increase in serum creatinine level greater than 0.5 mg/dL (44.2 μmol/L) or a new requirement of dialy sis by O'Donnell and colleagues. 14 O'Donnell and colleagues 14 were the only authors to standardize AKI definitions to a standardized schema such as the RIFLE (Risk of renal dysfunction; Injury to the kidney; Failure of kidney function, Loss of kidney function and End-stage kidney disease) criteria 41 as determined by Vascular Quality Initiative requirements for publication.…”

Section: Cold Renal Perfusion Methodsmentioning

confidence: 99%

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Efficacy of cold renal perfusion protection for open complex aortic aneurysm repair: a meta-analysis

Grab

Krzyzaniak

Devrome

et al. 2022

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Background: Cold renal perfusion (CRP) with 4°C crystalloid fluids has been described as a method to reduce renal injury during open surgical repair of complex aortic aneurysms (cAAs) (those requiring at least a suprarenal clamp site). We performed a meta-analysis to ascertain whether CRP improves kidney-related outcomes after open surgical cAA repair.Methods: Patients of any age or gender who had undergone open surgical repair of cAAs were included. Primary outcomes were the presence of postoperative kidney injury, the need for dialysis and mortality related to kidney injury. We compared patients who were treated with any intraoperative CRP strategy to a control population without CRP. We used a fixed-effects model to analyze derived odds ratios (ORs) and assess heterogeneity. We performed risk of bias analysis to identify potential confounding elements.Results: Among the 935 studies screened, 5 primary articles met the inclusion criteria. Cold renal perfusion significantly reduced postoperative acute kidney injury (OR 0.46 [95% confidence interval 0.32-0.68], Z = 3.98, p = 0.001). Only 1 study included data for the other primary outcomes. The data were considered homogeneous, with Cochrane Q = 0.23 and I 2 of 0%. Conclusion:This meta-analysis showed reduced postoperative acute kidney injury with the use of CRP during open cAA repair. A prospective randomized controlled trial to perform further subgroup analysis and research the various types of CRP solutions may be warranted to identify further possible benefits.Contexte : La protection rénale hypothermique (PRH) au moyen de liquides cristalloïdes à 4 °C a été décrite en tant que méthode pour prévenir l'atteinte rénale lors des réparations d'anévrisme de l'aorte complexes (AAC) par chirurgie ouverte (qui nécessite au moins un clampage suprarénal). Nous avons procédé à une méta-analyse pour vérifier si la PRH améliore les paramètres rénaux après une réparation d'AAC par chirurgie ouverte.Méthodes : Nous avons inclus toutes les personnes (tous âges et sexes confondus) ayant subi une réparation d'AAC par chirurgie ouverte. Les paramètres principaux étaient atteinte rénale postopératoire, recours à la dialyse ou mortalité en lien avec l'insuffisance rénale. Nous avons comparé la population soumise à toute forme de PRH peropératoire à la population témoin non soumise à la PRH. Nous avons utilisé un modèle à effets fixes pour analyser les rapports des cotes (RC) dérivés et mesurer l'hétérogénéité. Nous avons effectué une analyse des risques de biais pour dégager de possibles variables de confusion.Résultats : Parmi les 935 études recensées, 5 articles principaux répondaient aux critères d'inclusion. La PRH a significativement contri bué à réduire l'atteinte rénale postopératoire aiguë (RC 0,46 [intervalle de confiance de 95 % 0,32-0,68], Z = 3,98, p = 0,001). Une seule étude incluait des données concernant les autres paramètres principaux. Les données ont été considérées homogènes, avec un test Q de Cochran = 0,23 et un coefficient I 2 de 0 %. Conclusion :Cette méta-...

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Section: Discussionmentioning

confidence: 99%

Section: Cold Renal Perfusion Methodsmentioning

confidence: 99%

Efficacy of cold renal perfusion protection for open complex aortic aneurysm repair: a meta-analysis

Grab

Krzyzaniak

Devrome

et al. 2022

cjs

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“…Beyond optimal perioperative care, the investigators from the Baylor College of Medicine have repeatedly demonstrated the safety and efficacy of selective, intermittent kidney perfusion with cold (4 C) Ringer's lactate solution (enriched with mannitol/methylprednisolone). 8,9 In this issue of the Journal, Kahlberg and colleagues 10 present results from the single-center, randomized, double-blind, 2-arm CURITIBA trial (CUstodiol vs RInger: whaT Is the Best Agent? A Randomized Double Blind Trial), which allocated 90 adult patients with TAAA undergoing elective surgical repair in a 1:1 fashion to standardized renal perfusion strategy with Custodiol or methylprednisolone/ mannitol-enriched Ringer's lactate solution both provided at 4 C, as suggested by Coselli and colleagues.…”

Section: Oliver J Liakopoulos MDmentioning

confidence: 99%

Commentary: Renal perfusion strategy during thoracoabdominal aortic repair—is Custodiol the answer?

Liakopoulos

2023

The Journal of Thoracic and Cardiovascular Surgery

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“…Preventing AKI can modify the mid-term survival after TAAA repair (37). Research confirmed that cold crystalloid perfusion during the period of arterial occlusion and reconstruction is critical for kidney protection (38). The visceral perfusion is selected to avoid the splanchnic hypoperfusion and to reduce gastrointestinal complications.…”

Section: Variables Medium(iqr) Mean±sdmentioning

confidence: 99%

The application of modular multifunctional left heart bypass circuit system integrated with ultrafiltration in thoracoabdominal aortic aneurysm repair

Huang

Chen

et al. 2022

Front. Cardiovasc. Med.

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Open thoracoabdominal aortic aneurysm (TAAA) repair is a complex and challenging operation with a high incidence of serious complications, and high perioperative mortality and morbidity. Left heart bypass (LHB) is a circulatory support system used to perfuse the distal aorta during TAAA operation, and the advantages of LHB include guaranteeing distal perfusion, reducing the use of heparin, and diminishing the risk of bleeding and postoperative neurological deficits. In China, the circuit for TAAA repair is deficient, and far from the perfusion requirements. We designed a modular multifunctional LHB circuit for TAAA repair. The modular circuit consisted of cannulation pipelines, functional consumables connection pipelines, and accessory pipelines. The accessory pipelines make up lines for selective visceral perfusion and kidney perfusion, suckers and rapid infusion. The circuit can be assembled according to surgical requirements. The ultrafilter and heat exchanger are integrated into the circuit to fulfill the basic demands of LHB. The LHB circuit also has pipelines for selective visceral perfusion to the celiac artery and superior mesenteric artery and renal perfusion pipelines. Meanwhile, the reserved pipelines facilitate the quick switch from LHB to conventional cardiopulmonary bypass (CPB). The reserved pipelines reduce the time of reassembling the CPB circuit. Moreover, the rapid infusion was integrated into the LHB circuit, which can rapid infusion when massive hemorrhage during the open procedures such as exposure and reconstruction of the aorta. The ultrafiltration can diminish the consequent hemodilution of hemorrhage and rapid infusion. A hemoperfusion cartridge also can be added to reduce the systemic inflammatory during operation. The circuit can meet the needs of LHB and quickly switch to conventional CPB. No oxygenator was required during LHB, which reduce the use of heparin and reduce the risk of bleeding. The heat exchanger contributes to temperature regulation; ultrafiltration, arterial filter, and rapid-infusion facilitated the blood volume management and are useful to maintain hemodynamic stability. This circuit made the assembly of the LHB circuit more easily, and more efficient, which may contribute to the TAAA repair operation performed in lower volume centers easily. 26 patients who received TAAA repair under the modular multifunctional LHB from January 2018-March 2022 were analyzed, and we achieved acceptable clinical outcomes. The in-hospital mortality and 30-day postoperative mortality were 15.4%, and the postoperative incidences of paraparesis (4%), stroke (4%), and AKI need hemodialysis (12%) were not particularly high, based on the limited patients sample size in short research period duration.

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Renal perfusion with histidine-tryptophan-ketoglutarate compared with Ringer's solution in patients undergoing thoracoabdominal aortic open repair

Cited by 26 publications

References 23 publications

Efficacy of cold renal perfusion protection for open complex aortic aneurysm repair: a meta-analysis

Efficacy of cold renal perfusion protection for open complex aortic aneurysm repair: a meta-analysis

Commentary: Renal perfusion strategy during thoracoabdominal aortic repair—is Custodiol the answer?

The application of modular multifunctional left heart bypass circuit system integrated with ultrafiltration in thoracoabdominal aortic aneurysm repair

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