Renal perfusion during thoracoabdominal aortic operations: cold crystalloid is superior to normothermic blood

Ann Thorac Surg. 2002 Mar;73(3):730-8. doi: 10.1016/s0003-4975(01)03575-5.


Background: Renal failure remains a common complication of thoracoabdominal aortic aneurysm repair. The purpose of this randomized clinical trial was to compare two methods of selective renal perfusion--cold crystalloid perfusion versus normothermic blood perfusion--and determine which technique provides the best kidney protection during thoracoabdominal aortic aneurysm repair.

Methods: Thirty randomized patients undergoing Crawford extent II thoracoabdominal aortic aneurysm repair with left heart bypass had renal artery perfusion with either 4 degrees C Ringer's lactate solution (14 patients) or normothermic blood from the bypass circuit (16 patients). Acute renal dysfunction was defined as an elevation in serum creatinine level exceeding 50% of baseline within 10 postoperative days.

Results: One death occurred in each group. One patient in the blood perfusion group experienced renal failure requiring hemodialysis. Ten patients (63%) in the blood perfusion group and 3 patients (21%) in the cold crystalloid perfusion group experienced acute renal dysfunction (p = 0.03). Multivariable analysis confirmed that the use of cold crystalloid perfusion was independently protective against acute renal dysfunction (p = 0.02; odds ratio, 0.133).

Conclusions: When using left heart bypass during repair of extensive thoracoabdominal aortic aneurysms, selective cold crystalloid perfusion offers superior renal protection when compared with conventional normothermic blood perfusion.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Cardioplegic Solutions / therapeutic use*
  • Female
  • Heart Bypass, Left / methods*
  • Humans
  • Ischemia / prevention & control
  • Kidney / blood supply*
  • Male
  • Middle Aged
  • Potassium Compounds / therapeutic use*
  • Viscera / blood supply


  • Cardioplegic Solutions
  • Potassium Compounds
  • potassium cardioplegic solution