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

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.