P372. Utilizing Hyperoxygenated Blood During Left Heart Bypass for Thoracoabdominal Aortic Aneurysm Repairs to Reduce Postoperative Renal Dysfunction
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Baylor College of Medicine
Houston, TX
United States - Contact Me
Medical school: University of Washington School of Medicine
Residency: University of California, Davis Integrated Cardiothoracic Surgery Residency
Fellowship: Advanced Aortic Surgery Fellowship at Baylor College of Medicine/Texas Heart Institute
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: Renal dysfunction after thoracoabdominal aortic aneurysm (TAAA) repair remains a significant and common complication despite continuing research on and improvements in renal perfusion methods, surgical technique, and perioperative care. In the hope of reducing renal dysfunction rates after TAAA repair, we tested a novel technique of using hyperoxygenated blood to perfuse the downstream aorta with selective visceral perfusion during repair.
Methods: Since February 2023, we have provided intraoperative hyperoxygenated blood to 11 patients undergoing TAAA repair. This was done by adding an oxygenator to our left heart bypass (LHB) circuit to increase the partial pressure of oxygen (PaO2) in the blood as it is exposed to 100% fraction of inspired oxygen (FiO2) via the oxygenator before returning to the patient. A heat exchanger was also utilized to maintain normothermia. Heparin was administered for ACT ≥ 250. Separate return lines with balloon perfusion catheters provided hyperoxygenated blood to the celiac trunk, superior mesenteric artery, and bilateral renal arteries as part of selective visceral perfusion. No additional cold blood or perfusate was administered to the renal or visceral arteries. Postoperative complications including renal dysfunction and persistent paraplegia were evaluated.
Results: Among the patients (age range 37-77 years), baseline preoperative creatinine level was 0.86-3.34 mg/dL and eGFR was 24-111mL/min/1.73m2; 2 patients had non-dialysis-dependent chronic kidney disease at baseline. Most repairs were elective (n=9), and 7 patients underwent extent II TAAA repair. All patients received selective visceral perfusion and LHB during repair and 9 underwent cerebrospinal fluid drainage. Of the 11 patients, only 1 developed postoperative acute renal dysfunction (with creatinine elevation greater than 50% above baseline creatinine level within 10 operative days) but did not need dialysis. None of the patients had persistent renal failure on discharge. There was also no incidence of mesenteric ischemia, return to the operating room for bleeding, or persistent postoperative paraplegia. One patient died of cerebral herniation due to subarachnoid hemorrhage from an undiagnosed intracranial aneurysm on postoperative day 7 and another patient died suddenly on postoperative day 18 of unknown causes.
Conclusions: This preliminary work suggests that using LHB with hyperoxygenated blood to perfuse renal and visceral arteries during TAAA repair produces favorable results, even for patients with baseline chronic renal dysfunction and elevated serum creatinine levels. Future steps include conducting a formal clinical trial of hyperoxygenated blood as an LHB perfusate in patients undergoing TAAA repair to evaluate the utility and significance of this novel technique. LHB with hyperoxygenated blood should also be evaluated as a potential method to reduce spinal cord deficits and pulmonary complications in these patients.
Authors
Anna Xue (1), vicente Orozco Sevilla (2), Nguyen Le (2), Veronica Glover (1), Susan Green (2), Ginger Etheridge (3), Subhasis Chatterjee (4), Marc Moon (5), Joseph Coselli (6)
Institutions
(1) Baylor College of Medicine/Texas Heart Institute, Houston, TX, (2) Baylor St. Luke's/Texas Heart Institute, Houston, TX, (3) Baylor College of Medicine, Houston, TX, (4) Baylor St. Luke's Medical Center, Houston, TX, (5) Baylor College of Medicine / Texas Heart Institute, Houston, TX, (6) Baylor College of Medicine, Texas Heart Institute, Houston, TX
Methods: Since February 2023, we have provided intraoperative hyperoxygenated blood to 11 patients undergoing TAAA repair. This was done by adding an oxygenator to our left heart bypass (LHB) circuit to increase the partial pressure of oxygen (PaO2) in the blood as it is exposed to 100% fraction of inspired oxygen (FiO2) via the oxygenator before returning to the patient. A heat exchanger was also utilized to maintain normothermia. Heparin was administered for ACT ≥ 250. Separate return lines with balloon perfusion catheters provided hyperoxygenated blood to the celiac trunk, superior mesenteric artery, and bilateral renal arteries as part of selective visceral perfusion. No additional cold blood or perfusate was administered to the renal or visceral arteries. Postoperative complications including renal dysfunction and persistent paraplegia were evaluated.
Results: Among the patients (age range 37-77 years), baseline preoperative creatinine level was 0.86-3.34 mg/dL and eGFR was 24-111mL/min/1.73m2; 2 patients had non-dialysis-dependent chronic kidney disease at baseline. Most repairs were elective (n=9), and 7 patients underwent extent II TAAA repair. All patients received selective visceral perfusion and LHB during repair and 9 underwent cerebrospinal fluid drainage. Of the 11 patients, only 1 developed postoperative acute renal dysfunction (with creatinine elevation greater than 50% above baseline creatinine level within 10 operative days) but did not need dialysis. None of the patients had persistent renal failure on discharge. There was also no incidence of mesenteric ischemia, return to the operating room for bleeding, or persistent postoperative paraplegia. One patient died of cerebral herniation due to subarachnoid hemorrhage from an undiagnosed intracranial aneurysm on postoperative day 7 and another patient died suddenly on postoperative day 18 of unknown causes.
Conclusions: This preliminary work suggests that using LHB with hyperoxygenated blood to perfuse renal and visceral arteries during TAAA repair produces favorable results, even for patients with baseline chronic renal dysfunction and elevated serum creatinine levels. Future steps include conducting a formal clinical trial of hyperoxygenated blood as an LHB perfusate in patients undergoing TAAA repair to evaluate the utility and significance of this novel technique. LHB with hyperoxygenated blood should also be evaluated as a potential method to reduce spinal cord deficits and pulmonary complications in these patients.
Authors
Anna Xue (1), vicente Orozco Sevilla (2), Nguyen Le (2), Veronica Glover (1), Susan Green (2), Ginger Etheridge (3), Subhasis Chatterjee (4), Marc Moon (5), Joseph Coselli (6)
Institutions
(1) Baylor College of Medicine/Texas Heart Institute, Houston, TX, (2) Baylor St. Luke's/Texas Heart Institute, Houston, TX, (3) Baylor College of Medicine, Houston, TX, (4) Baylor St. Luke's Medical Center, Houston, TX, (5) Baylor College of Medicine / Texas Heart Institute, Houston, TX, (6) Baylor College of Medicine, Texas Heart Institute, Houston, TX
Presentation Duration
PODS will be on display in the exhibit hall for the duration of the meeting during exhibit hall hours. PODS will also be available for viewing on the meeting website. There is no formal presentation associated with your POD, but we encourage you to visit the PODS area during breaks to connect with those viewing.