Discussion

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Dr Richard Cambria (Boston, Mass). Congratulations on a well-conducted and obviously exhaustively detailed study. I think you've shown, and it's always nice to see, data that reinforces one's bias that cold crystalloid perfusion, of course, can be a very effective means of renal protection during these extensive operations. And my major question was detailed on your slide that your data showed that the renal ischemic times are really identical between the two.

Of course, we also know that the patients with baseline abnormal renal function are those that are at the highest risk for perioperative renal dysfunction. So I certainly agree with the conclusions and the tenets of your study. And although it's not the topic of this study, I wonder if you could give us your data or thoughts on cold renal protection in those with baseline renal insufficiency.

Dr Coselli. Absolutely, it was not the intent of this particular evaluation to determine whether one technique was superior over another in patients with preoperative renal dysfunction. In fact, as I showed, impaired renal function was an exclusion criterion for this specific randomized trial.

However, off the cuff (and leaning more towards opinion but somewhat away from speculation), just based on experience, we have employed cold crystalloid perfusion in patients with preoperative renal dysfunction and have found it to be quite favorable; but we haven't analyzed it in a rigorous statistical way, so it nowhere near approaches Level 1 data.