Related Experiment Video
Updated: Jul 5, 2026
Steps for the Autologous Ex vivo Perfused Porcine Liver-kidney Experiment
Published on: December 18, 2013
Implementation of a goal directed perfusion strategy to reduce cardiac surgery associated kidney injury: A before and
Jules Loeb1, Geoffroy Hariri2, Vincenzo Montana1
1Sorbonne Université, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Département d'anesthésie et réanimation, Institut de Cardiologie, Hôpital La Pitié-Salpêtrière, F-75013 Paris, France.
Insights
Implementing Goal Directed Perfusion (GDP) during cardiopulmonary bypass (CPB) significantly reduced acute kidney injury (AKI) after cardiac surgery. This strategy offers a promising approach to improving patient outcomes in cardiac surgery populations.
Area of Science:
- Cardiology
- Nephrology
- Surgical Critical Care
Background:
- Cardiac surgery-associated acute kidney injury (CSA-AKI) is a significant complication.
- Goal Directed Perfusion (GDP) during cardiopulmonary bypass (CPB) aims to mitigate post-operative issues, including CSA-AKI.
Purpose of the Study:
- To evaluate the impact of implementing a GDP strategy during CPB on the incidence of CSA-AKI.
- To assess CSA-AKI in a large, unselected cardiac surgery patient cohort.
Main Methods:
- Retrospective, before-and-after study design.
- Inclusion of all patients undergoing cardiac surgery with CPB.
- Primary endpoint: incidence of AKI (KDIGO classification); Secondary endpoints: ICU mortality, length of stay, and other complications.
Main Results:
- The incidence of AKI was significantly lower after GDP implementation (27.6% vs. 40.5%, p < 0.001).
- GDP was an independent protective factor against AKI (OR 0.37, p < 0.001), particularly for stage 1 AKI.
- No significant changes were observed in ICU mortality, length of stay, or other post-operative complications.
Conclusions:
- GDP strategy implementation during CPB is associated with a reduction in postoperative AKI.
- GDP demonstrates effectiveness in mitigating early-stage AKI following cardiac surgery.
Purpose:
Cardiac surgery associated acute kidney injury (CSA-AKI) is a frequent and severe complication. Goal Directed Perfusion (GDP) during cardiopulmonary bypass (CPB) has been developed to reduce post-operative complications, in particular CSA-AKI. Hence, we aimed to assess the implementation of a GDP strategy during CPB on the incidence of CSA-AKI in a large, unselected cardiac surgery population.
Methods:
We conducted a retrospective, before and after study, including all patients admitted to our surgical intensive care unit (ICU) following a cardiac surgery with CPB in the year prior to GDP implementation (No-GDP group), and in the year following its implementation (GDP group). Primary endpoint was the incidence of acute kidney injury (AKI) according to KDIGO classification in each group. Secondary endpoints were ICU mortality and length of stay, and the main post-operative complications after cardiac surgery. Risk factors of AKI were evaluated using a multivariable logistic regression model.
Results:
Among 903 patients in our analysis, 314 (34 %) developed AKI. The incidence of AKI was lower after the implementation of GDP strategy (n = 111; 27.6 % vs n = 203; 40.5 %, p < 0.001). In the multivariable analysis, GDP was an independent factor of AKI reduction (OR 0.37, 95 %CI [0.27-0.52], p < 0.001). This benefit was significant regarding stage 1 AKI, but not stage 2 or 3 AKI. GDP was not associated with a change in post-operative ICU mortality, length of stay or any other post-operative complication.
Conclusion:
GDP strategy implantation during CPB is associated with a reduction of postoperative AKI.
