Liao Xinyi, Luo Dan, Lin Jing, Tan Zhaoxia, Xiong Jiyue, Du Lei
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Front Cardiovasc Med. 2025 Apr 28;12:1514247. doi: 10.3389/fcvm.2025.1514247. eCollection 2025.
Total aortic arch replacement surgery (TARS) for Acute type A aortic dissection is associated with high incidence of postoperative acute kidney injury (AKI), at least partly due to the lower body ischemia during circulatory arrest. This study aimed to evaluate whether retrograde inferior vena cava perfusion (RIVP) reduces the risk of AKI by providing oxygenated blood to the lower body.
This retrospective study utilized a medical recording system to screen patients who underwent TARS from January 1 to December 31, 2019. Patients were assigned to receive antegrade cerebral perfusion (ACP) only or ACP + RIVP during circulatory arrest. The primary outcome was postoperative AKI. Oxygen delivery, consumption, and extraction ratio during RIVP were also determined.
Of all included 87 patients, postoperative AKI occurred in 35 (40%), of whom 23 (53.5%) were in the ACP, and 12 (27.3%) were in the ACP + RIVP ( = 0.013). In regression analysis, ACP + RIVP was associated with lower risk of AKI than ACP alone (adjusted OR 0.229; 95% CI 0.071-0.746). RIVP at a pressure of 22.5 ± 3.8 mmHg delivered 0.98 ± 0.34 ml/min/kg of oxygen to the lower body, and the partial oxygen pressure decreased from 359 ± 57 mmHg in RIVP blood to 64 ± 30 mmHg in returning blood. Oxygen extraction ratio was 44 ± 16%, which correlated negatively with peak postoperative creatinine levels ( = -0.58, = 0.01) and creatinine increase ( = -0.61, = 0.009). No correlations were found between oxygen delivery and postoperative creatinine or creatinine increase.
RIVP may reduce the risk of postoperative AKI in a manner that depends on the tissue oxygen extraction ratio.
急性A型主动脉夹层的全主动脉弓置换手术（TARS）与术后急性肾损伤（AKI）的高发生率相关，至少部分原因是循环停止期间下半身缺血。本研究旨在评估逆行下腔静脉灌注（RIVP）通过向下半身提供含氧血液是否能降低AKI的风险。
这项回顾性研究利用医疗记录系统筛选2019年1月1日至12月31日期间接受TARS的患者。患者被分配在循环停止期间仅接受顺行脑灌注（ACP）或ACP + RIVP。主要结局是术后AKI。还测定了RIVP期间的氧输送、消耗和提取率。
在纳入的87例患者中，35例（40%）发生术后AKI，其中23例（53.5%）在ACP组，12例（27.3%）在ACP + RIVP组（P = 0.013）。在回归分析中，与单独的ACP相比，ACP + RIVP与较低的AKI风险相关（校正OR 0.229；95% CI 0.071 - 0.746）。压力为22.5±3.8 mmHg的RIVP向下半身输送0.98±0.34 ml/min/kg的氧气，氧分压从RIVP血液中的359±57 mmHg降至回流血中的64±30 mmHg。氧提取率为44±16%，与术后肌酐峰值水平呈负相关（r = -0.58，P = 0.01）和肌酐增加量呈负相关（r = -0.61，P = 0.009）。未发现氧输送与术后肌酐或肌酐增加量之间存在相关性。
RIVP可能以依赖于组织氧提取率的方式降低术后AKI的风险。
