Advanced perfusion strategy for renal protection in juxtarenal aortic aneurysms: a pilot study

OBJECTIVES: Open surgical treatment of juxtarenal aortic aneurysms (JAAA) is often associated with acute kidney injury (AKI). Therefore, intraoperative organ protection during supra-renal clamping is decisive for the outcome. This study describes the use of a low-profile extracorporeal circulation (LPECC) for selective renal perfusion in open surgery of JAAA. METHODS: From 2018 to 2024, 23 patients with JAAA underwent open aortic repair with suprarenal cross-clamping with organ protection by LPECC. This retrospective case series without control group investigated the effect of pressure- and volume-controlled renal perfusion during clamping on clinical outcome in terms of prevention of AKI after open surgery. To classify postoperative renal dysfunction, the RIFLE classification (risk, injury, failure, loss, end-stage renal disease) was used. AKI was defined in the postoperative course as a decrease in eGFR of more than 50% (RIFLE class ≥ 2). Renal function was monitored after 30-days and 1-year with regard to the need for dialysis, course of renal parameters and the occurrence of complications. RESULTS: The intraoperative use of the LPECC was not associated with any intraoperative complications. In the postoperative course, 17% developed temporary AKI (RIFLE class ≥ 2, n = 4) of which 3 patients required dialysis. During 30-days and 1-year follow-up, the retention values recovered and decreased to the preoperative level. None of the investigated patients required long-term dialysis. CONCLUSIONS: Monitored pressure- and volume-controlled renal perfusion could improve management and outcome in patients with JAAA. LPECC represents a safe and feasible surgical method for renal protection.