Impact of cardiopulmonary bypass management on postcardiac surgery renal function

Abstract

Our data suggest that current clinical CPB management impacts postoperative renal function. We found that patients with normal preoperative renal function who developed postoperative ARF had longer CPB duration, lower CPB perfusion flow, and longer periods on CPB at pressures < 60 mmHg compared to patients with no post CPB ARF. However, our data do not allow us to separate these CPB-related factors from the potential influence of perioperative low cardiac output syndrome as a cause for postoperative ARF. Thus, future clinical studies are required to elucidate CPB-induced ARF and to optimize CPB management for ARF prevention.

Serum creatinine role in predicting outcome after cardiac surgery beyond acute kidney injury

“…Current data is insufficient to confirm the association between these CPB parameters and the risk of CSA-AKI [2,71] . Other more established CPB-related risk factors are duration of CPB (> 100-120 min), perfu- Najafi M. Creatinine, AKI and cardiac surgery outcome sion pressure, hemodilution during CPB, blood transfusion, hemolysis, most commonly due to cardiotomy suction, and embolism [2,95,96] . The role of CPB in inducing systemic inflammatory response syndrome (SIRS) and consequently CSA-AKI has been shown in different cardiac surgery events.…”

Advanced Perfusion Techniques - Flow versus Pressure

“…[24] Furthermore, the more time MAP is below 50mmHg or 60mmHg during CPB, the more likely is for acute renal injury (AKI) to arise. [25,26] Kanji and colleagues also found that a drop in MAP bigger than 26mmHg during CPB compared to pre-bypass MAP was associated with AKI. [27] Blood Flow versus Blood Pressure: "Pros and Cons"…”

The Anesthetic Management of a Patient with Marfan Syndrome and Renal Transplant Patient Undergoing Bentall Operation

“…KBP süresi arttıkça ve KBP sıra-sında 60 mmHg altındaki düşük perfüzyon basıncı ile bu düşük perfüzyon periyotlarının uzunluğu postoperatif böbrek yetmezliği görülme insidansının artmasında en önemli faktör olarak kabul edilmektedir (5) . Hipotermi, nonpulsatil sirkulasyon, düşük kardiyak output sendromu ile kanamaya bağlı hipotansiyon ve hipovolemiye bağlı perfüzyon bozuklukları gibi nedenler özellikle renal transplant hastalarında infeksiyon ve greft rejeksiyon riskini arttırmaktadır (7) .…”

“…Preoperatif dönemde normal böbrek fonksiyonuna sahip hastalarda bile postoperatif dönemde % 4 ile 7.7 oranında böbrek yetmezliği gelişebilmektedir. Hipotermi ve hipovolemiye bağlı düşük perfüzyon basıncı ile pulsatil olmayan kan akımı postoperatif böbrek yetmezliğinin en önemli faktörleri olarak kabul edilmektedir (5,6) . Aynı nedenlerle renal transplantasyon yapılmış hastalarda allogreft böbreğin enfeksiyon, disfonksiyon ve greft rejeksiyon riski daha da yüksektir (7) .…”