94% of researchers rate our articles as excellent or good
Learn more about the work of our research integrity team to safeguard the quality of each article we publish.
Find out more
ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Clinical and Translational Cardiovascular Medicine
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1514247
Retrograde inferior vena cava perfusion reduces the risk of acute kidney injury depending on the oxygen extraction ratio. A retrospective cohort study
Provisionally accepted- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Total aortic arch replacement surgery (TARS) for Acute type A aortic dissection is associated with high incidence of postoperative acute kidney injury (AKI), at least partly due to the lower body ischemia during circulatory arrest. This study aimed to evaluate whether retrograde inferior vena cava perfusion (RIVP) reduces the risk of AKI by providing oxygenated blood to the lower body.Methods: This retrospective study utilized a medical recording system to screen patients who underwent TARS from January 1 to December 31, 2019. Patients were assigned to receive antegrade cerebral perfusion (ACP) only or ACP+RIVP during circulatory arrest. The primary outcome was postoperative AKI. Oxygen delivery, consumption, and extraction ratio during RIVP were also determined.Results: Of all included 87 patients, postoperative AKI occurred in 35 (40%), of whom 23 (53.5%) were in the ACP, and 12 (27.3%) were in the ACP+RIVP (P=0.013). In regression analysis, ACP+RIVP was associated with lower risk of AKI than ACP alone (adjusted OR 0.229; 95% CI 0.071-0.746). RIVP at a pressure of 22.5±3.8 mmHg delivered 0.98±0.34 mL/min/kg of oxygen to the lower body, and the partial oxygen pressure decreased from 359±57 mmHg in RIVP blood to 64±30 mmHg in returning blood. Oxygen extraction ratio was 44±16%, which correlated negatively with peak postoperative creatinine levels (r=-0.58, P=0.01) and creatinine increase (r=-0.61, P=0.009). No correlations were found between oxygen delivery and postoperative creatinine or creatinine increase.RIVP may reduce the risk of postoperative AKI in a manner that depends on the tissue oxygen extraction ratio.
Keywords: Acute type A aortic dissection, Acute Kidney Injury, Retrograde inferior vena cava perfusion, antegrade cerebral perfusion, ERO2
Received: 25 Oct 2024; Accepted: 16 Apr 2025.
Copyright: © 2025 Liao, Luo, Lin, Tan, Xiong and Du. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jiyue Xiong, Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
Lei Du, Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.