Hepatic and renal effects of cardiopulmonary bypass

Tomasso, Nora Di; Monaco, Fabrizio; Landoni, Giovanni

doi:10.1016/j.bpa.2015.04.001

Cited by 26 publications

(19 citation statements)

References 79 publications

(83 reference statements)

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“…[8] summarized the primary data about the severe liver dysfunction after CPB that can occur in high-risk patients with a reduced physiological reserve. Pre-operative risk factors are right-side heart failure, moderate-to-severe tricuspid regurgitation, pulmonary hypertension (systolic pulmonary pressure above 45 mmHg), high preload [central venous pressure (CVP) above 8 mmHg] chronic heart failure, New York Heart Association (NYHA) class II-IV and low ejection fraction [8] are at a higher risk to develop liver dysfunction after CPB. Interestingly, as reported by Van Deursen et al [9] , in 323 patients with heart failure, the hemodynamic profile can affect the liver function tests (LFTs).…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary Bypass Ischemic Hepatitis Reported in Five Patients

Damasceno¹,

Filho²,

Chahud³

et al. 2016

Brazilian Journal of Cardiovascular Surgery

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ObjectiveIn cardiac surgery, the lung, renal and neurological events are the most frequent complications. Less common, acute liver failure is a serious complication that adds high morbidity, mortality, and costs. Therefore, this communication aimed to retrospectively evaluate five patients who presented, in 2014, severe acute liver failure in the immediate postoperative period.MethodsRetrospective data analysis of patients' medical records that showed severe liver failure has been computed in the medical records of five patients undergoing cardiac surgery at the Hospital da Faculdade de Medicina de Ribeirão Preto – USP in the immediate postoperative period from February 1, 2014 to December 12, 2014. The study selected five males patients, 60 to 67 years old, cardiopulmonary bypass mean time of 101.4 minutes (varying from 80 to 140 minutes), who presented acute perioperative liver failure.ResultsThe five patients showed an impressive increase of blood transaminase (serum alanine aminotransferase), suggesting acute hepatitis. The evolution of all patients was catastrophic, with severe hemodynamic effects and death. Many studies suggest that systemic hypotension is an important pathogenic factor for ischemic hepatitis. However, our data and previous studies raise the possibility that other yet unknown factors other than hypotension may be part of the pathophysiology of cardiopulmonary bypass after ischemic hepatitis (anticoagulation inadequate for the quality of heparin and protamine, etc.).ConclusionCurrently, there are no conclusive studies on the prevention of perioperative liver failure. More well-designed studies are needed on the introduction and evolution of liver dysfunction after cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

Cardiopulmonary Bypass Ischemic Hepatitis Reported in Five Patients

Damasceno¹,

Filho²,

Chahud³

et al. 2016

Brazilian Journal of Cardiovascular Surgery

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“…Preoperative risk factors for postoperative hepatic failure include right-sided heart failure, moderate-to-severe tricuspid regurgitation, pulmonary hypertension (pulmonary artery systolic pressure greater than 45 mmHg), high preload chronic heart failure, New York Heart Association class II to IV, and low ejection fraction. 4 There are several theories to explain the mechanism for postoperative liver dysfunction at the cellular level. The systemic inflammatory response syndrome and oxidative stress from CPB can contribute to postoperative hepatic injury.…”

mentioning

confidence: 99%

Liver Dysfunction in Cardiac Surgery – What Causes It and Is There Anything We Can Do?

Chacon

Schulte

2018

Journal of Cardiothoracic and Vascular Anesthesia

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“…CSA-AKI is believed to originate intraoperatively, 15 the cumulative result of ischemic insults, 15 , 16 , 17 , 18 , 19 systemic inflammation, 20 , 21 , 22 , 23 and oxidative stress, 17 , 22 , 24 , 25 ultimately resulting in progression to tubular necrosis. Animal models consistently demonstrate the potential to abrogate or prevent AKI with a variety of pharmaceutical approaches targeting these mechanisms, 26 , 27 , 28 , 29 , 30 provided the treatment is instituted before significant tubular cell death occurs.…”

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confidence: 99%

Improving the Prediction of Cardiac Surgery–Associated Acute Kidney Injury

Crosina

Lerner

et al. 2017

Kidney International Reports

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IntroductionAcute kidney injury (AKI) is a potentially fatal complication of cardiac surgery. The inability to predict cardiac surgery-associated AKI is a major barrier to prevention and early treatment. Current clinical risk models for the prediction of cardiac surgery-associated AKI are insufficient, particularly in patients with preexisting kidney dysfunction.MethodsTo identify intraoperative variables that might improve the performance of a validated clinical risk score (Cleveland Clinic Score, CCS) for the prediction of cardiac surgery-associated AKI, we conducted a prospective cohort study in 289 consecutive elective cardiac surgery patients at a tertiary care center. We compared the area under the receiver operator characteristic curve (AUC) of a base model including only the CCS with models containing additional selected intraoperative variables including mean arterial pressure, hematocrit, duration of procedure, blood transfusions, and fluid balance. AKI was defined by the Kidney Disease Improving Global Outcomes 2012 criteria.ResultsThe CCS alone gave an AUC of 0.72 (95% confidence interval, 0.62–0.82) for postoperative AKI. Nadir intraoperative hematocrit was the only variable that improved AUC for postoperative AKI when added to the CCS (AUC = 0.78; 95% confidence interval, 0.70–0.87; P = 0.002). In the subcohort of patients without preexisting chronic kidney disease (n = 214), where the CCS underperformed (AUC, 0.60 [0.43–0.76]), the improvement with the addition of nadir hematocrit was more marked (AUC, 0.74 [0.62–0.86]). Other variables did not improve discrimination.DiscussionNadir intraoperative hematocrit is useful in improving discrimination of clinical risk scores for AKI, and may provide a target for intervention.

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Hepatic and renal effects of cardiopulmonary bypass

Cited by 26 publications

References 79 publications

Cardiopulmonary Bypass Ischemic Hepatitis Reported in Five Patients

Cardiopulmonary Bypass Ischemic Hepatitis Reported in Five Patients

Liver Dysfunction in Cardiac Surgery – What Causes It and Is There Anything We Can Do?

Improving the Prediction of Cardiac Surgery–Associated Acute Kidney Injury

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