Introducing the BARTAAAKI (Barts Thoracoabdominal Aortic Acute Kidney Injury) Bundle: Renal Recovery Following Thoracoabdominal Aortic Repair.

OBJECTIVE

To evaluate the association between the implementation of a modified KDIGO-based renal protection bundle (BARTAAAKI) and postoperative renal outcomes following open thoracoabdominal aortic aneurysm (TAAA) repair.

DESIGN

Single-center, unadjusted retrospective cohort study.

SETTING

Tertiary cardiovascular referral center.

PARTICIPANTS

A total of 113 consecutive patients undergoing open TAAA repair between September 2017 and August 2023, comprising 86 prebundle and 27 BARTAAAKI bundle patients. Patients receiving preoperative dialysis or dying within 72 hours were excluded. All Crawford extents and aortic pathologies were included.

INTERVENTIONS: Implementation of the BARTAAAKI perioperative renal protection bundle.

MEASUREMENTS AND MAIN

RESULTS

The median patient age was 60 years (range, 20-79 years), and 81% were male. Severe acute kidney injury (AKI; KDIGO stage 2-3) at 72 hours was less frequent in the BARTAAKI group compared to the prebundle group (56% vs 80%; absolute risk difference, -25 percentage points; 95% confidence interval [CI], -44 to -5; p = 0.02). Renal recovery at hospital discharge was more frequent after bundle implementation (93% vs 69%; absolute risk difference, +24 percentage points; 95% CI, +6 to +36; p = 0.01). Renal replacement therapy was required in 41% of patients in the BARTAAKI group compared to 52% of prebundle patients (absolute risk difference, -12 percentage points; 95% CI, -31 to +10; p = 0.38). The rate of Custodiol (histidine-tryptophan-ketoglutarate) use in the 2 groups was 58% vs 89% (p = 0.02).

CONCLUSIONS

Implementation of the BARTAAAKI bundle was associated with greater renal recovery and less severe AKI after open TAAA repair. These unadjusted observational findings require confirmation in prospective studies.