Reduced @entity177 following XXXX repair by selective perfusion.

@entity1 @entity8 @entity1593 @entity63 @entity254 @entity532 @entity177 @entity2334 @entity439
OBJECTIVES: @entity177 and @entity63 are feared complications following @entity2334 ( @entity2334 ) repair, significantly contributing to mortality. This prospective study describes volume- and pressure-controlled perfusion of the @entity8 during @entity2334 surgery. METHODS: In 73 consecutive @entity1 (mean age 59 years), @entity2334 repair (27 type I, 28 type II, 8 type III and 10 type IV) was performed, using retrograde and selective organ perfusion. Sixteen @entity1 had @entity8 with blood creatinine higher than 100 mmol/l. During the thoracic part of the procedure, the mean distal aortic pressure was kept above 60 mm Hg by means of left-heart bypass. After opening the abdominal aorta, the @entity8 were individually perfused by means of perfusion catheters (9 French) in the first 33 @entity1 (group I). Volume flow through each catheter was assessed with ultrasound flow meters and maintained at least at 60 ml/min. In addition to volume flow measurements, catheters with pressure sensors were used in the last 40 @entity1 (group II), allowing pressure-controlled selective perfusion. The extent of the @entity439 was comparable in both groups. RESULTS: Mean cross-clamp time for the thoracic part was 46 min, including proximal @entity254 and reattachment of intercostal arteries. Mean cross-clamp time for the abdominal part was 74 min, including re-implantation of intestinal and renal arteries and selective dacron grafts to the @entity1593 arteries (n = 5), superior mesenteric arteries (n = 8) and renal arteries (n = 25), through which the catheters guaranteed continuous perfusion during the time the @entity254 was performed. Urine output was uninterrupted in all @entity1 , irrespective of cross-clamp time. In group I, one @entity1 (3%) developed @entity177 and three @entity1 (9%) required temporary peritoneal dialysis. In group II, no @entity1 developed @entity177 and two @entity1 (5%) required temporary peritoneal dialysis. Thirteen @entity1 with pre-existing @entity8 did not deteriorate. No @entity1 developed @entity63 or multiple-organ failure. Total in-hospital mortality was 6/73 (8%) and was related to @entity532 . CONCLUSIONS: Renal and @entity63 can be reduced significantly by continuous perfusion during cross-clamping in @entity2334 repair. Not only sufficient volume flow but also adequate arterial pressure appears to be essential in maintaining renal function.
