The effect of renin-angiotensin system blockade on visceral blood flow during and after thoracic aortic cross-clamping

A. W. Joob, P. K. Harman, D. L. Kaiser, I. L. Kron

Research output: Contribution to journalArticle

29 Scopus citations

Abstract

Surgical procedures necessitating clamping of the thoracic aorta are associated with a high incidence of postoperative renal dysfunction. Plasma renin activity is elevated during and after thoracic aortic occlusion in animals. The pathophysiology of the renal dysfunction may involve the renin-angiotensin system. Blockade of the renin-angiotensin system was studied in a canine model during occlusion of the thoracic aorta. Saralasin, a competitive blocker of angiotensin II, and the converting enzyme inhibitor MK422 were studied. Sixteen animals were separated into three treatment groups: control (five animals), saralasin (five), and MK422 (six). All dogs underwent clamping of the thoracic aorta for 60 minutes. In control animals, plasma renin activity increased from 0.16 ± 0.04 to 6.41 ± 1.57 ng/ml/hr at 30 minutes after thoracic aortic occlusion (p<0.05). Thirty minutes after cross-clamp release, plasma renin activity remained 10 times greater than baseline, 1.47 ± 0.20 ng/ml/hr (p<0.05). Renal blood flow was measured with 15 μm microspheres before, during, and after thoracic clamping. In control animals, renal cortical blood flow decreased during cross-clamping and remained below baseline after clamp release: baseline, 7.05 ± 0.98 ml/gm/min (standard error of the mean); 30 min after clamp, 3.77 ± 0.43 ml/gm/min (standard error of the mean) (p<0.05). In the MK422 group, renal cortical blood flows returned to baseline after cross-clamp release: baseline, 6.38 ± 0.49 ml/gm/min; 30 minutes after clamp release, 7.30 ± 1.6 ml/gm/min. Infusion of MK422 after placement of the thoracic aortic cross-clamp resulted in normal renal blood flow after clamp release. This protective effect was not seen with saralasin. The resumption of normal renal cortical blood flow after the administration of the converting enzyme inhibitor MK422 suggests that elevated plasma renin activity may contribute to renal dysfunction after thoracic aortic occlusion.

Original languageEnglish (US)
Pages (from-to)411-418
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume91
Issue number3
DOIs
StatePublished - 1986
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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