Effectiveness of lower body perfusion strategy for prevention of renal injury in infants undergoing aortic arch repair

Bazylev V.V.

Federal Center for Cardiovascular Surgery

ORCID: 0000-0001-6089-9722

Shcheglova K.T.

Federal Center for Cardiovascular Surgery

ORCID: 0000-0001-8468-4806

Magilevets A.I.

Federal Center for Cardiovascular Surgery

ORCID: 0000-0003-0586-5671

Shikhranov A.A.

Federal Center for Cardiovascular Surgery

ORCID: 0000-0001-9971-3390

Bofanov D.A.

Federal Center for Cardiovascular Surgery

ORCID: 0000-0003-0492-8845

Vostokova E.V.

Federal Center for Cardiovascular Surgery

ORCID: 0000-0002-9458-9180

Effectiveness of lower body perfusion strategy for prevention of renal injury in infants undergoing aortic arch repair

Authors:

Bazylev V.V., Shcheglova K.T., Magilevets A.I., Shikhranov A.A., Bofanov D.A., Vostokova E.V.

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Journal: Russian Journal of Cardiology and Cardiovascular Surgery. 2025;18(2): 142‑149

DOI: 10.17116/kardio202518021142

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To cite this article:

Bazylev VV, Shcheglova KT, Magilevets AI, Shikhranov AA, Bofanov DA, Vostokova EV. Effectiveness of lower body perfusion strategy for prevention of renal injury in infants undergoing aortic arch repair. Russian Journal of Cardiology and Cardiovascular Surgery. 2025;18(2):142‑149. (In Russ.)
https://doi.org/10.17116/kardio202518021142

Подписка 2025-2 (Russian Journal of Cardiology and Cardiovascular Surgery)

Использование инфографики авторами научных работ

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OBJECTIVE

To evaluate the effectiveness of lower body perfusion strategy for prevention of renal injury in infants undergoing aortic arch repair.

MATERIAL AND METHODS

A retrospective study included 47 patients who underwent aortic arch repair between August 2021 and November 2023. Patients were divided into two groups. The first group included 24 patients who underwent sustainable total perfusion in all regions (STAR-perfusion) combining selective antegrade cerebral perfusion (SACP), heart and lower body. The second group consisted of 23 patients who underwent SACP under moderate hypothermia.

RESULTS

The incidence of AKI was 33.3% and 47.8%, respectively (p=0.07). In the SACP group, maximum intraoperative serum lactate was higher, and this difference persisted for 24 hours after surgery. Patients in the second group required longer treatment in ICU (p<0.0001), but length of hospital-stay did not differ between groups (p=0.023). There were no deaths in both groups. In multivariate regression analysis, we found significant effect of CPB time > 120 min and maximum intraoperative serum lactate >5 mmol/l on AKI after aortic arch reconstruction.

CONCLUSION

The STAR-strategy does not reduce the incidence of AKI after aortic arch reconstruction in young children compared to SACP under moderate hypothermia. However, this approach is accompanied by lower disturbances in tissue perfusion, as evidenced by lower serum lactate on the first day after surgery, as well as less need for catecholamine support.

Keywords:

children

newborns

aortic arch reconstruction

STAR perfusion

sustained total all region perfusion

acute kidney injury

Authors:

Bazylev V.V.

Federal Center for Cardiovascular Surgery

ORCID: 0000-0001-6089-9722

Shcheglova K.T.

Federal Center for Cardiovascular Surgery

ORCID: 0000-0001-8468-4806

Magilevets A.I.

Federal Center for Cardiovascular Surgery

ORCID: 0000-0003-0586-5671

Shikhranov A.A.

Federal Center for Cardiovascular Surgery

ORCID: 0000-0001-9971-3390

Bofanov D.A.

Federal Center for Cardiovascular Surgery

ORCID: 0000-0003-0492-8845

Vostokova E.V.

Federal Center for Cardiovascular Surgery

ORCID: 0000-0002-9458-9180

Received:

23.01.2024

Accepted:

15.02.2024

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