A prospective randomized study to evaluate splanchnic hypoxia during beating-heart and conventional coronary revascularization

Velissaris, Theo

doi:10.1016/s1010-7940(03)00167-2

Cited by 52 publications

(31 citation statements)

References 24 publications

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“…Disagreements were resolved through consensus. Eleven authors were contacted by e-mail (up to three attempts per author) for additional information, including confirmation that there were no duplicate data and clarification of the AKI definition used in trials (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Five authors provided additional information (25,29,30,32,33).…”

Section: Data Abstractionmentioning

confidence: 99%

“…A total of 6256 potentially relevant citations were identified and screened, of which 5232 originated from MEDLINE; 224 articles were retrieved for detailed evaluation, of which 22 fulfilled eligibility criteria ( Figure 1) (25)(26)(27)(28)(29)(30)(32)(33)(34)(35)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…All 22 studies reported on the incidence of AKI, with seven studies defining AKI exclusively as the need for dialysis (25,26,33,47,49 -51). Six studies did not describe the criteria used to define AKI (27,34,35,42,46,48). The remaining nine studies defined AKI using variable absolute or relative increases in serum creatinine, decreases in GFR, decreases in urine output, or need for dialysis (Table 2) (28 -30,32,43-45, 52,53).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The remaining nine studies defined AKI using variable absolute or relative increases in serum creatinine, decreases in GFR, decreases in urine output, or need for dialysis (Table 2) (28 -30,32,43-45, 52,53). Death was ascertained in-hospital in nine trials (25,(27)(28)(29)32,34,46,48,51), at 30 days in nine trials (25,26,30,33,35,44,45,47,53), and at 60 days in one trial (42). The duration of follow-up was not documented in the three remaining studies (43,50,52).…”

Section: Study Characteristicsmentioning

confidence: 99%

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Off-Pump Coronary Artery Bypass Surgery and Acute Kidney Injury

Seabra

Alobaidi

Balk

et al. 2010

Clinical Journal of the American Society of Nephrology

118

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Background and objectives: Off-pump coronary artery bypass grafting (CABG) has been advocated to cause less inflammation, morbidity, and mortality than the more traditional on-pump technique. This meta-analysis compares these two surgical techniques with respect to causing acute kidney injury (AKI).Design, setting, participants, & measurements: This study searched for randomized controlled trials in MEDLINE and abstracts from the proceedings of scientific meetings through February 2010. Included were trials comparing off-pump to on-pump CABG that reported the incidence of AKI, as defined by a mixture of criteria including biochemical parameter/urine output/dialysis requirement. Mortality was evaluated among the studies that reported kidney-related outcomes. For primary and subgroup analyses, fixed-effect meta-analyses of odds ratios (OR) were performed.Results: In 22 identified trials (4819 patients), the weighted incidence of AKI in the on-pump CABG group was 4.0% (95% confidence interval [CI] 1.8%, 8.5%), dialysis requirement 2.4% (95% CI 1.6%, 3.7%), and mortality 2.6% (95% CI 1.6%, 4.0%). By meta-analysis, off-pump CABG was associated with a 40% lower odds of postoperative AKI (OR 0.60; 95% CI 0.43, 0.84; P ‫؍‬ 0.003) and a nonsignificant 33% lower odds for dialysis requirement (OR 0.67; 95% CI 0.40, 1.12; P ‫؍‬ 0.12). Within the selected trials, off-pump CABG was not associated with a significant decrease in mortality.Conclusions: Off-pump CABG may be associated with a lower incidence of postoperative AKI but may not affect dialysis requirement, a serious complication of cardiac surgery. However, the different definitions of AKI used in individual trials and methodological concerns preclude definitive conclusions.

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Section: Data Abstractionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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Off-Pump Coronary Artery Bypass Surgery and Acute Kidney Injury

Seabra

Alobaidi

Balk

et al. 2010

Clinical Journal of the American Society of Nephrology

118

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“…An increase in the contractile response to alpha1-adrenergic agonist and an early release of pro-inflammatory substances has been observed after CPB [140][141][142] . Nevertheless, the effect of pulseless extracorporeal circulation on bowel hypoperfusion is still under debate [143,144] , and off-pump coronary artery bypass does not prevent subsequent mesenteric ischemia [134,145,146] . The physiologic changes in intestinal perfusion during cardiac surgery remain to be elucidated.…”

Section: Ami After Cpbmentioning

confidence: 99%

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Abboud¹,

Daher²,

Boujaoude³

2008

WJG

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Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency. Several pathophysiologic events (arterial obstruction, venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow. Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities, leading to multi-organ failure and death. Early diagnosis is difficult because the clinical presentation is subtle, and the biological and radiological diagnostic tools lack sensitivity and specificity. Therapeutic options vary from conservative resuscitation, medical treatment, endovascular techniques and surgical resection and revascularization. A high index of suspicion is required for diagnosis, and prompt treatment is the only hope of reducing the mortality rate. Studies are in progress to provide more accurate diagnostic tools for early diagnosis. AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB). Several factors contribute to the systemic hypo-perfusion state, which is the most frequent pathophysiologic event. In this particular setting, the clinical presentation of AMI can be misleading, while the laboratory and radiological diagnostic tests often produce inconclusive results. The management strategies are controversial, but early treatment is critical for saving lives. Based on the experience of our team, we consider prompt exploratory laparotomy, irrespective of the results of the diagnostic tests, is the only way to provide objective assessment and adequate treatment, leading to dramatic reduction in the mortality rate.

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Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease

Møller

Penninga

Wetterslev

et al. 2012

Cochrane Database of Systematic Reviews

143

118

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Our systematic review did not demonstrate any significant benefit of off-pump compared with on-pump CABG regarding mortality, stroke, or myocardial infarction. In contrast, we observed better long-term survival in the group of patients undergoing on-pump CABG with the use of cardiopulmonary bypass and cardioplegic arrest. Based on the current evidence, on-pump CABG should continue to be the standard surgical treatment. However, off-pump CABG may be acceptable when there are contraindications for cannulation of the aorta and cardiopulmonary bypass. Further randomised clinical trials should address the optimal treatment in such patients.

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A prospective randomized study to evaluate splanchnic hypoxia during beating-heart and conventional coronary revascularization

Cited by 52 publications

References 24 publications

Off-Pump Coronary Artery Bypass Surgery and Acute Kidney Injury

Off-Pump Coronary Artery Bypass Surgery and Acute Kidney Injury

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease

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