Comparative evaluation of visceral and renal protection methods during thoracoabdominal aortic repair (Experience of Russian Surgery Research Center named after B.V. Petrovsky)

The objective: to compare the effectiveness of visceral and renal protection methods during thoracoabdominal aortic (TAA) repair: left atrial-femoral bypass (LAFB) and cardiopulmonary bypass (CPB) in conjunction with selective perfusion (SP) of these organs.

Subjects: 81 patients who underwent TAA repair were enrolled in retrospective analysis: LAFB was used in 29 patients (Group 1), CPB and SP ‒ in 52 patients (Group 2).

Results. In Group 2, there were lower intraoperative blood loss volume (1,500 ml vs 4,200 ml, p < 0.001), significantly lower levels of direct bilirubin, blood creatinine, blood alpha-amylase in postoperative period, significantly shorter duration of hospital stay, ICU stay and duration of mechanical ventilation. Also in this group, there were lower incidence of multiple organ dysfunction (11.5% vs 37.9%, p = 0.005), stroke (0 vs 10.3%, p = 0.043), lower need for requirement (3.8% vs 20.7%, p = 0.022) and mortality (3.8% vs 27.6%, p = 0.003).

Conclusion: During TAA repair, CPB in conjunction with selective visceral and renal perfusion is more beneficial for organ protection as compared with LAFB.

1. Belov Yu.V., Vinokurov I.А. Acute renal failure after operations on thoracoabdominal aorta under organs protection with solution custodiol. Kardiologiya i Serdechno-Sosudistaya Khirurgiya, 2014, vol. 7, no. 4, pp. 24-28. (In Russ.)

2. Belov Yu.V., Khamitov F.F. Surgical protection of the spinal cord and visceral organs during thoracoabdominal aortic replacement. Grudnaya i Serdechno-Sosudistaya Khirurgiya, 2000, vol. 4, pp. 54-57. (In Russ.)

3. Belov Yu.V., Charchyan E.R., Stepanenko А.B. et al. Surgical treatment of patients with thoracoabdominal aortic aneurysms. Khirurgiya. Journal im. N. I. Pirogova, 2015, vol. 12, pp. 33-38. (In Russ.)

4. Komarov R.N., Vinokurov I.А., Karavaykin P.А. et al. A staged method of hybrid prosthetics of the thoracoabdominal aorta. Khirurgiya. Journal im. N. I. Pirogova, 2018, no. 2, pp. 21-27. (In Russ.)

5. Mamaev А.N., Kudlay D.А. Statisticheskiye metody v meditsine. [Statistical methods in medicine]. Moscow, Prakticheskaya Meditsina Publ., 2021, 136 p. ISBN 978-5-98811-635-6.

6. Patent RUS 2343856 as of 20.09.2010. no. 2, Belov Yu.V., Komarov R.N., Guleshov V.А. Sposob zashchity vistseralnykh organov pri khirurgicheskom lechenii torakoabdominalnykh anevrizm aorty. [The method of protection of visceral organs during surgery of thoracoabdominal aortic aneurysms]. Accessed 12.03.2021.

7. Achouh P.E., Madsen K., Miller C.C. et al. Gastrointestinal complications after descending thoracic and thoracoabdominal aortic repairs: A 14-year experience. J. Vasc. Surg., 2006, vol. 44, pp. 442‒446. https://doi.org/10.1016/j.jvs.2006.05.018.

8. Aftab M., Coselli J.S. Renal and visceral protection in thoracoabdominal aortic surgery. J. Thorac. Cardiovasc. Surg., 2014, vol. 148, pp. 2963‒2966. https://doi.org/10.1016/j.jtcvs.2014.06.072.

9. Corvera J., Copeland H., Blitzer D. et al. Open repair of chronic thoracic and thoracoabdominal aortic dissection using deep hypothermia and circulatory arrest. J. Thorac. Cardiovasc. Surg., 2017, vol. 154, no. 2, pp. 389‒395. https://doi.org/10.1016/j.jtcvs.2017.03.020.

10. Coselli J.S., de la Cruz K.I., Preventza O. et al. Extent II thoracoabdominal aortic aneurysm repair: How I do it. Seminars Thorac. Cardiovasc. Surg., 2016, vol. 28, pp. 221‒237. https://doi.org/10.1053/j.semtcvs.2016.07.005.

11. Coselli J.S, LeMaire S.A., Preventza O. et al. Outcomes of 3309 thoracoabdominal aortic aneurysm repairs. J. Thorac. Cardiovasc. Surg., 2016, vol. 151, no. 5, pp. 1323‒1337. https://doi.org/10.1016/j.jtcvs.2015.12.050.

12. Coselli J.S. Strategies for renal and visceral protection in thoracoabdominal aortic surgery. J. Thorac. Cardiovasc. Surg., 2010, vol. 140, pp. 147‒149. https://doi.org/10.1016/j.jtcvs.2010.07.038.

13. Estrera A.L., Sandhu H.K., Charlton-Ouw K.M. et al. A quarter century of organ protection in open thoracoabdominal repair. Ann. Surgery, 2015, vol. 262, pp. 660–668. https://doi.org/10.1097/SLA.0000000000001432.

14. Hassoun H.T., Miller C.C., Huynh T.T.T. et al. Cold visceral perfusion improves early survival in patients with acute renal failure after thoracoabdominal aortic aneurysm repair. J. Vasc. Surg., 2004, vol. 39, pp. 506‒512. https://doi.org/10.1016/j.jvs.2003.09.040.

15. Köksoy C., LeMaire S.A., Curling P.E. et al. Renal perfusion during thoracoabdominal aortic operations: cold crystalloid is superior to normothermic blood. Ann. Thorac. Surg., 2002, vol. 73, pp. 730‒738. https://doi.org/10.1016/S0003-4975(01)03575-5.

16. Kunihara T., Shiiya N., Wakasa S., et al. Assessment of hepatosplanchnic pathophysiology during thoracoabdominal aortic aneurysm repair using visceral perfusion and shunt. Eur. J. Cardio-Thoracic Surg., 2009, vol. 35, pp. 677‒683. https://doi.org/10.1016/j.ejcts.2008.12.016.

17. Kuniyoshi Y., Koja K., Miyagi K., et al. Selective visceral perfusion during thoracoabdominal aortic aneurysm repair. Ann. Thorac. Cardiovasc. Surg., 2004, vol. 10, pp. 367‒372.

18. LeMaire S.A., Jones M.M., Conklin L.D. et al. Randomized comparison of cold blood and cold crystalloid renal perfusion for renal protection during thoracoabdominal aortic aneurysm repair. J. Vasc. Surg., 2009, vol. 49, pp. 11‒19. https://doi.org/10.1016/j.jvs.2008.08.048.

19. Monnot A., Dusseaux M.M., Godier S. et al. Passive temporary visceral shunt from the axillar artery as an adjunct method during the open treatment of thoracoabdominal aortic aneurysm. Ann. Vasc. Surg., 2016, vol. 36, pp. 127‒131. https://doi.org/10.1016/j.avsg.2016.03.031.

20. Schepens M.A., Heijmen R.H., Ranschaert W. et al. Thoracoabdominal aortic aneurysm repair: results of conventional open surgery. Eur. J. Vasc. Endovasc. Surg., 2009, vol. 37, pp. 640‒645. https://doi.org/10.1016/j.ejvs.2009.03.011.

21. Schepens M.A. Left heart bypass for thoracoabdominal aortic aneurysm repair: technical aspects. Multimed. Manual Cardio-Thorac. Surg., 2016, https://doi.org/10.1093/mmcts/mmv039.

22. Tshomba Y., Kahlberg A., Melissano G. et al. Comparison of renal perfusion solutions during thoracoabdominal aortic aneurysm repair. J. Vascul. Surg., 2014, vol. 59, pp. 623‒633. https://doi.org/10.1016/0741-5214(93)90421-H.

23. Waked K., Schepens M. State-of the-art review on the renal and visceral protection during open thoracoabdominal aortic aneurysm repair. J. Visualiz. Surg., 2018, vol. 4, pp. 31. https://doi.org/10.21037/jovs.2018.01.12.

24. Whitlock R.S., Coselli J.S. Review: perspectives on renal and visceral protection during thoracoabdominal aortic aneurysm repair. Indian J. Thorac. Cardiovasc. Surg., 2019, vol. 35, suppl. 2). pp. 179‒185. https://doi.org/10.1007/s12055-018-0757-5.

25. Wong D.R., Parenti J.L., Green S.Y. et al. Open repair of thoracoabdominal aortic aneurysm in the modern surgical era: contemporary outcomes in 509 patients. J. Amer. College of Surgeons, 2011, vol. 212, pp. 569‒579. https://doi.org/10.1016/j.jamcollsurg.2010.12.041.

26. Wu D., Coselli J.S., Johnson M.L. et al. Hepatopancreaticobiliary values after thoracoabdominal aneurysm repair. Aorta (Stamford), 2014, pp. 135‒142. https://doi.org/10.12945/j.aorta.2014.14-015.