Perioperative Incidence of Acute Renal Failure in Aortic Arch Reconstruction Using Retrograde Selective Lower Body Perfusion in Neonates and Infants

Objective

Examination of the impact of retrograde selective lower body perfusion (SLP) via a femoral arterial catheter on urine output and the incidence of acute kidney injury (AKI) during pediatric aortic arch reconstructions. The secondary objective was if the cannulation of the superficial femoral artery was associated with complications in the perfusion area.

Design

A retrospective study over an 8-year period (January 2015 to December 2023).

Setting

Pediatric heart center of a tertiary care hospital.

Participants

Neonates and infants (N = 104) undergoing elective aortic arch reconstruction with cardiopulmonary bypass, of whom 45 received retrograde SLP.

Interventions

Retrograde SLP via ultrasound-guided, weight-adapted femoral artery catheters for retrograde perfusion during clamping of the descending aorta under surgery, compared to a control group with identical surgical, perfusion, and anesthesiologic management but without SLP.

Measurements and Main Results

Perioperative AKI incidence was analyzed using KDIGO criteria at multiple predetermined time points, along with urinary output. The SLP group showed a significantly lower AKI incidence immediately and 6 hours postsurgery (p = 0.001). Higher urine output postoperatively until day 3 (p ≤ 0.045) in the SLP group. No vascular complications were observed until hospital discharge.

Conclusions

Retrograde SLP is associated with a reduced AKI incidence and increased postoperative urine output, without vascular complications. Further studies are needed to investigate the long-term effects of retrograde SLP on renal function.