Miniaturized Cardiopulmonary Bypass and Acute Kidney Injury in Coronary Artery Bypass Graft Surgery

Benedetto, Umberto; Luciani, Remo; Goracci, Massimo; Capuano, Fabio; Refice, Simone; Angeloni, Emiliano; Roscitano, Antonino; Sinatra, Riccardo

doi:10.1016/j.athoracsur.2009.03.072

Cited by 69 publications

(54 citation statements)

References 20 publications

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“…provides better tissue perfusion. This theory is supported by previous studies revealing decreased troponin and creatinine kinase myocardial band (CK-MB) levels, as well as kidney and liver parameters after 'mini-CPB' surgeries [6,7]. To the best of our knowledge, studies that used retrograde autologous priming did not reveal statistically significant differences in the levels of myocardial ischaemia.…”

Section: Discussionsupporting

confidence: 73%

Can cardiopulmonary bypass system with blood priming become a new standard in coronary surgery?

Mak¹,

Smolka

Kowalski

et al. 2016

Kardiol Pol

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A b s t r a c tBackground: Commonly used cardiopulmonary bypass systems with cardiotomy reservoir, oxygenator, and roller pump require preoperative crystalloid filling. Radical reduction of the filling fluid volume and replacing it with the patient's own blood has a fundamental impact on the outcome. Aim:A comparison of cardiopulmonary bypass filled with the patient's blood, applied in Poland for the first time, and the classical system filled with crystalloids.Methods: Non-randomised trial in which patients undergoing coronary artery bypass grafting were divided into two groups: first operated on with use of cardiopulmonary bypass system with the patient's own blood priming, and a control group operated on with standard technique. Levels of haemoglobin (HGB), haematocrit (HCT), platelets, leukocytes, creatinine, protein, C-reactive protein, procalcitonin, volume of transfused blood products, postoperative drain output, time to extubation, and consumption of catecholamines were compared. Results:The results of a study comparing the classical system with the blood-filled system (n = 60) showed a significantly smaller decrease in HGB and HCT levels (p = 0.001), resulting in reduction of blood product transfusions by 75% (p = 0.03). The new type of extracorporeal circulation reduced the total postoperative drain output by approximately 28% (p = 0.003). The systemic inflammatory response syndrome (SIRS) was less pronounced and the tissue perfusion was better due to smaller degree of haemodilution leading to better organ and heart protection. The patients required shorter mechanical ventilation times in the perioperative period. Conclusions:The use of a new system of cardiopulmonary bypass filled with the patient's blood reduces the postoperative decrease in HGB and HCT, the amount of transfused blood products, and total postoperative drain output. It also shortens the time spent on mechanical ventilatory support.

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Section: Discussionsupporting

confidence: 73%

Can cardiopulmonary bypass system with blood priming become a new standard in coronary surgery?

Mak¹,

Smolka

Kowalski

et al. 2016

Kardiol Pol

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“…Although transfusions were shown to increase the probability of acute lung injury (ALI) (45) and mortality (46) in patients with septic shock, a similar relationship with AKI has not been previously demonstrated in this patient group. Perioperative and postoperative red blood cell transfusions were independent risk factors for AKI in patients undergoing cardiopulmonary bypass (47,48). An immunologic mechanism is postulated.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Acute Kidney Injury in Septic Shock Patients

Plataki¹,

Kashani²,

Cabello-Garza³

et al. 2011

Clinical Journal of the American Society of Nephrology

162

107

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SummaryBackground and objectives Acute kidney injury (AKI) is a frequent complication in critically ill patients and sepsis is the most common contributing factor. We aimed to determine the risk factors associated with AKI development in patients with septic shock.Design, setting, participants, & measurements Observational cohort study consisted of consecutive adults with septic shock admitted to a medical intensive care unit (ICU) of a tertiary care academic hospital from July 2005 to September 2007. AKI was defined according to RIFLE criteria (urine output and creatinine criteria). Demographic, clinical, and treatment variables were reviewed. Main outcomes measured were AKI occurrence, all-cause hospital mortality, and hospital and ICU length of stay.Results Three hundred ninety patients met inclusion criteria, of which 237 (61%) developed AKI. AKI development was independently associated with delay to initiation of adequate antibiotics, intra-abdominal sepsis, blood product transfusion, use of angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker, and body mass index (kg/m 2 ). Higher baseline GFR and successful early goal directed resuscitation were associated with a decreased risk of AKI. Hospital mortality was significantly greater in patients who developed AKI (49 versus 34%).Conclusions In a contemporary cohort of patients with septic shock, both patient and health care delivery risk factors seemed to be important for AKI development.

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“…Immer et al [59] reported a significantly lower serum IL-6 level in the mini-ECC group which correlated with a significantly reduced incidence of AKI. Benedetto et al [60] reported that the incidence of AKI, as classified by AKIN, in patients undergoing CABG was 40.5% in the standard CPB group compared to 28% in the mini-ECC group (p = 0.03). At this time, there is little data comparing mini-ECC and off-pump technique.…”

Section: Optimizing Cardiac Surgical Procedures and Cpb Parametersmentioning

confidence: 99%

Cardiac Surgery-Associated Acute Kidney Injury

Mao

Katz²,

Ariyanon³

et al. 2013

Cardiorenal Med

197

141

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Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common and serious postoperative complication of cardiac surgery requiring cardiopulmonary bypass (CPB), and it is the second most common cause of AKI in the intensive care unit. Although the complication has been associated with the use of CPB, the etiology is likely multifactorial and related to intraoperative and early postoperative management including pharmacologic therapy. To date, very little evidence from randomized trials supporting specific interventions to protect from or prevent AKI in broad cardiac surgery populations has been found. The definition of AKI employed by investigators influences not only the incidence of CSA-AKI, but also the identification of risk variables. The advent of novel biomarkers of kidney injury has the potential to facilitate the subclinical diagnosis of CSA-AKI, the assessment of its severity and prognosis, and the early institution of interventions to prevent or reduce kidney damage. Further studies are needed to determine how to optimize cardiac surgical procedures, CPB parameters, and intraoperative and early postoperative blood pressure and renal blood flow to reduce the risk of CSA-AKI. No pharmacologic strategy has demonstrated clear efficacy in the prevention of CSA-AKI; however, some agents, such as the natriuretic peptide nesiritide and the dopamine agonist fenoldopam, have shown promising results in renoprotection. It remains unclear whether CSA-AKI patients can benefit from the early institution of such pharmacologic agents or the early initiation of renal replacement therapy.

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Miniaturized Cardiopulmonary Bypass and Acute Kidney Injury in Coronary Artery Bypass Graft Surgery

Cited by 69 publications

References 20 publications

Can cardiopulmonary bypass system with blood priming become a new standard in coronary surgery?

Can cardiopulmonary bypass system with blood priming become a new standard in coronary surgery?

Predictors of Acute Kidney Injury in Septic Shock Patients

Cardiac Surgery-Associated Acute Kidney Injury

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