{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:50:03Z","timestamp":1753890603159,"version":"3.41.2"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T00:00:00Z","timestamp":1745798400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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\u2009+\u2009RIVP during circulatory arrest. The primary outcome was postoperative AKI. Oxygen delivery, consumption, and extraction ratio during RIVP were also determined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\u2009+\u2009RIVP (<jats:italic>P<\/jats:italic>\u2009=\u20090.013). In regression analysis, ACP\u2009+\u2009RIVP was associated with lower risk of AKI than ACP alone (adjusted OR 0.229; 95% CI 0.071\u20130.746). RIVP at a pressure of 22.5\u2009\u00b1\u20093.8 mmHg delivered 0.98\u2009\u00b1\u20090.34\u2005ml\/min\/kg of oxygen to the lower body, and the partial oxygen pressure decreased from 359\u2009\u00b1\u200957\u2005mmHg in RIVP blood to 64\u2009\u00b1\u200930\u2005mmHg in returning blood. Oxygen extraction ratio was 44\u2009\u00b1\u200916%, which correlated negatively with peak postoperative creatinine levels (<jats:italic>r<\/jats:italic>\u2009=\u2009\u22120.58, <jats:italic>P<\/jats:italic>\u2009=\u20090.01) and creatinine increase (<jats:italic>r<\/jats:italic>\u2009=\u2009\u22120.61, <jats:italic>P<\/jats:italic>\u2009=\u20090.009). No correlations were found between oxygen delivery and postoperative creatinine or creatinine increase.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>RIVP may reduce the risk of postoperative AKI in a manner that depends on the tissue oxygen extraction ratio.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1514247","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T05:29:54Z","timestamp":1745818194000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Retrograde inferior vena cava perfusion reduces the risk of acute kidney injury depending on the oxygen extraction ratio. A retrospective cohort study"],"prefix":"10.3389","volume":"12","author":[{"given":"Xinyi","family":"Liao","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Luo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhaoxia","family":"Tan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiyue","family":"Xiong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lei","family":"Du","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2806","DOI":"10.1016\/j.ijcard.2012.07.008","article-title":"Acute aortic dissection: epidemiology and outcomes","volume":"167","author":"Pacini","year":"2013","journal-title":"Int J Cardiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2611","DOI":"10.1161\/CIRCULATIONAHA.106.630400","article-title":"Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002","volume":"114","author":"Olsson","year":"2006","journal-title":"Circulation"},{"key":"B3","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1016\/j.hlc.2014.10.009","article-title":"Risk factors for hospital death in patients with acute aortic dissection","volume":"24","author":"Zhang","year":"2015","journal-title":"Heart Lung Circ"},{"key":"B4","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1177\/1538574415624767","article-title":"A meta-analysis of total arch replacement with frozen elephant trunk in acute type A aortic dissection","volume":"50","author":"Takagi","year":"2016","journal-title":"Vasc Endovascular Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.1016\/j.jtcvs.2009.07.045","article-title":"Selective antegrade cerebral perfusion via right axillary artery cannulation reduces morbidity and mortality after proximal aortic surgery","volume":"138","author":"Halkos","year":"2009","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2927","DOI":"10.1016\/j.jtcvs.2014.07.024","article-title":"Safety and efficacy of retrograde cerebral perfusion as an adjunct for cerebral protection during surgery on the aortic arch","volume":"148","author":"Girardi","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1016\/j.jtcvs.2012.07.063","article-title":"Selective antegrade cerebral perfusion and mild (28\u00b0C\u201330\u00b0C) systemic hypothermic circulatory arrest for aortic arch replacement: results from 1002 patients","volume":"144","author":"Zierer","year":"2012","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.athoracsur.2008.03.037","article-title":"Combining classic surgery with descending stent grafting for acute DeBakey type I dissection","volume":"86","author":"Jakob","year":"2008","journal-title":"Ann Thorac Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1053\/j.semtcvs.2019.03.012","article-title":"Mesenteric malperfusion in acute aortic dissection: challenges and frontiers","volume":"31","author":"Velayudhan","year":"2019","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e67","DOI":"10.1016\/j.athoracsur.2018.08.013","article-title":"Combining cerebral perfusion with retrograde Inferior vena caval perfusion for aortic arch surgery","volume":"107","author":"Lin","year":"2019","journal-title":"Ann Thorac Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1186\/s13063-019-3319-2","article-title":"Retrograde inferior vena caval perfusion for total aortic arch replacement surgery (RIVP-TARS): study protocol for a multicenter, randomized controlled trial","volume":"20","author":"Lin","year":"2019","journal-title":"Trials"},{"key":"B12","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/s0003-4975(00)01535-6","article-title":"Total arch replacement using aortic arch branched grafts with the aid of antegrade selective cerebral perfusion","volume":"70","author":"Kazui","year":"2000","journal-title":"Ann Thorac Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1874","DOI":"10.1016\/s0003-4975(99)00411-7","article-title":"Antegrade cerebral perfusion with cold blood: a 13-year experience","volume":"67","author":"Bachet","year":"1999","journal-title":"Ann Thorac Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1704","DOI":"10.1016\/0003-4975(95)00735-0","article-title":"Retrograde abdominal visceral perfusion: is it beneficial","volume":"60","author":"Rao","year":"1995","journal-title":"Ann Thorac Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1016\/s0749-0704(05)70288-8","article-title":"Determination of oxygen delivery and consumption versus cardiac index and oxygen extraction ratio","volume":"12","author":"Vincent","year":"1996","journal-title":"Crit Care Clin"},{"key":"B16","doi-asserted-by":"publisher","first-page":"R31","DOI":"10.1186\/cc5713","article-title":"Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury","volume":"11","author":"Mehta","year":"2007","journal-title":"Crit Care"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1419","DOI":"10.1016\/j.athoracsur.2018.03.003","article-title":"The society of thoracic surgeons 2018 adult cardiac surgery risk models: part 2-statistical methods and results","volume":"105","author":"O'Brien","year":"2018","journal-title":"Ann Thorac Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"2210","DOI":"10.1053\/j.jvca.2018.02.026","article-title":"Acute kidney injury after total arch replacement combined with frozen elephant trunk implantation: incidence, risk factors, and outcome","volume":"32","author":"Zhou","year":"2018","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e273","DOI":"10.1097\/MD.0000000000000273","article-title":"Potentially modifiable risk factors for acute kidney injury after surgery on the thoracic aorta: a propensity score matched case-control study","volume":"94","author":"Kim","year":"2015","journal-title":"Medicine (Baltimore)"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1313","DOI":"10.1016\/j.athoracsur.2016.04.007","article-title":"The impact of deep versus moderate hypothermia on postoperative kidney function after elective aortic hemiarch repair","volume":"102","author":"Arnaoutakis","year":"2016","journal-title":"Ann Thorac Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1827","DOI":"10.1016\/j.athoracsur.2008.07.024","article-title":"Evolving selective cerebral perfusion for aortic arch replacement: high flow rate with moderate hypothermic circulatory arrest","volume":"86","author":"Minatoya","year":"2008","journal-title":"Ann Thorac Surg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1358","DOI":"10.1016\/j.athoracsur.2005.11.062","article-title":"Aortic arch surgery: thoracoabdominal perfusion during antegrade cerebral perfusion may reduce postoperative morbidity","volume":"81","author":"Della Corte","year":"2006","journal-title":"Ann Thorac Surg"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1070","DOI":"10.1093\/ejcts\/ezt145","article-title":"Effects of intermittent lower body perfusion on end-organ function during repair of acute DeBakey type I aortic dissection under moderate hypothermic circulatory arrest","volume":"44","author":"Song","year":"2013","journal-title":"Eur J Cardiothorac Surg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/1010-7940(92)90096-g","article-title":"Deep hypothermic systemic circulatory arrest and continuous retrograde cerebral perfusion for surgery of aortic arch aneurysm","volume":"6","author":"Ueda","year":"1992","journal-title":"Eur J Cardiothorac Surg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1186\/s12872-021-02002-9","article-title":"Retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study","volume":"21","author":"Lin","year":"2021","journal-title":"BMC Cardiovasc Disord"},{"key":"B26","doi-asserted-by":"publisher","first-page":"820","DOI":"10.1093\/ejcts\/ezs500","article-title":"Acute type A aortic dissection: significance of multiorgan malperfusion","volume":"43","author":"Pacini","year":"2013","journal-title":"Eur J Cardiothorac Surg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1016\/s0749-0704(05)70287-6","article-title":"Oxygen delivery in critical illness","volume":"12","author":"Baigorri","year":"1996","journal-title":"Crit Care Clin"},{"key":"B28","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1097\/00024382-199408000-00008","article-title":"Vagal innervation influences the whole body oxygen consumption-delivery relationship in the dog","volume":"2","author":"Schertel","year":"1994","journal-title":"Shock"},{"key":"B29","doi-asserted-by":"publisher","first-page":"H1825","DOI":"10.1152\/ajpheart.1993.264.6.H1825","article-title":"Temperature dependence of oxygen diffusion and consumption in mammalian striated muscle","volume":"264","author":"Bentley","year":"1993","journal-title":"Am J Physiol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/0003-4975(94)91088-x","article-title":"Determination of organ blood flows during retrograde inferior vena caval perfusion","volume":"58","author":"Oohara","year":"1994","journal-title":"Ann Thorac Surg"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1514247\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T05:29:55Z","timestamp":1745818195000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1514247\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,28]]},"references-count":30,"alternative-id":["10.3389\/fcvm.2025.1514247"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2025.1514247","relation":{},"ISSN":["2297-055X"],"issn-type":[{"type":"electronic","value":"2297-055X"}],"subject":[],"published":{"date-parts":[[2025,4,28]]},"article-number":"1514247"}}