Advanced perfusion strategy for renal protection in juxtarenal aortic aneurysms: a pilot study

Open surgical treatment of juxtarenal aortic aneurysms (JAAA) is often associated with acute kidney injury (AKI). Therefore, intraoperative organ protection during supra-renal clamping is decisive for the outcome. This study describes the use of a low-profile extracorporeal circulation (LPECC) for selective renal perfusion in open surgery of JAAA. From 2018 to 2024, 23 patients with JAAA underwent open aortic repair with suprarenal cross-clamping with organ protection by LPECC. This retrospective case series without control group investigated the effect of pressure- and volume-controlled renal perfusion during clamping on clinical outcome in terms of prevention of AKI after open surgery. To classify postoperative renal dysfunction, the RIFLE classification (risk, injury, failure, loss, end-stage renal disease) was used. AKI was defined in the postoperative course as a decrease in eGFR of more than 50% (RIFLE class ≥ 2). Renal function was monitored after 30-days and 1-year with regard to the need for dialysis, course of renal parameters and the occurrence of complications. The intraoperative use of the LPECC was not associated with any intraoperative complications. In the postoperative course, 17% developed temporary AKI (RIFLE class ≥ 2, n = 4) of which 3 patients required dialysis. During 30-days and 1-year follow-up, the retention values recovered and decreased to the preoperative level. None of the investigated patients required long-term dialysis. Monitored pressure- and volume-controlled renal perfusion could improve management and outcome in patients with JAAA. LPECC represents a safe and feasible surgical method for renal protection.