A Technique for Reducing Coronary Bypass Morbidity in Patients with Compensated Renal Failure; Perioperative Ultrafiltration

Utku Alemdaroğlu; Öner Gülcan

Makale detayları

A Technique for Reducing Coronary Bypass Morbidity in Patients with Compensated Renal Failure; Perioperative Ultrafiltration

Yazarlar:

Utku Alemdaroğlu | Öner Gülcan

Yayıncı:

Selcuk University

Ana Başlıklar:

Klinik Tıp Bilimleri

Dergi:

Genel Tıp Dergisi Vol.33 Issue 2, pp.142-147

Belge Tipi:

Makale

Yayın Tarihi:

4/2023

Belge Dili:

İngilizce

Document ID (Org No.):

2001288868

pISSN:

2602-3741

Anahtar kelimeler:

Özet:

 INTRODUCTION: Preoperative renal dysfunction is one of the most important risk factors affecting postoperative morbidity and mortality in patients undergoing cardiac surgery. While patients with end-stage renal disease and dialysis-dependent constitute 1-3 of the renal failure spectrum, it should not be forgotten that coronary revascularization surgery is performed at a rate of 2-5 in the remaining asymptomatic majority. However, an optimal perioperative strategy has not been developed for this group of patients who have not yet undergone hemodialysis. In our study, conventional ultrafiltration was applied with a modified peroperative heart-lung machine and it was aimed to decrease mortality and morbidity. METHOD: 6303 patients who underwent coronary bypass surgery with the cardiopulmonary bypass technique between 2004 and 2011 at Başkent University Adana Hospitals were examined, and 99 patients with a preoperative serum creatinine level higher than 1.5 mgdl were included in this retrospective study. 99 patients were divided into two groups as UF performed 35 and not performed 64; They were evaluated in terms of drainage amounts, length of hospital stay, earlylate mortality and morbidity, and newly developing dialysis needs. RESULTS: There was no significant difference between the groups in terms of post-operative hemodialysis need, length of hospital stay and major complications. However; Peroperative ultrafiltration in obese, diabetic, recent MI, COPD and congestive heart failure patients; postoperatively less inotrope P0.0001, less diuretic requirement P0.0001, less colloidal fluid replacement p0.009, and relatively fewer minor complications. DISCUSSION AND CONCLUSION: Ultrafiltration to be applied during cardiopulmonary bypass in order to create a more balanced intravascular volume in patients with compensated renal failure, to reduce the need for volume expander fluid used for this purpose, to remove inflammation mediators that occur during cardiopulmonary bypass, and therefore to protect renal functions without the need for additional medication, especially COPD. We recommend it in the diabetic and obese patient group.

 INTRODUCTION: Preoperative renal dysfunction is one of the most important risk factors affecting postoperative morbidity and mortality in patients undergoing cardiac surgery. While patients with end-stage renal disease and dialysis-dependent constitute 1-3 of the renal failure spectrum, it should not be forgotten that coronary revascularization surgery is performed at a rate of 2-5 in the remaining asymptomatic majority. However, an optimal perioperative strategy has not been developed for this group of patients who have not yet undergone hemodialysis. In our study, conventional ultrafiltration was applied with a modified peroperative heart-lung machine and it was aimed to decrease mortality and morbidity. METHOD: 6303 patients who underwent coronary bypass surgery with the cardiopulmonary bypass technique between 2004 and 2011 at Başkent University Adana Hospitals were examined, and 99 patients with a preoperative serum creatinine level higher than 1.5 mgdl were included in this retrospective study. 99 patients were divided into two groups as UF performed 35 and not performed 64; They were evaluated in terms of drainage amounts, length of hospital stay, earlylate mortality and morbidity, and newly developing dialysis needs. RESULTS: There was no significant difference between the groups in terms of post-operative hemodialysis need, length of hospital stay and major complications. However; Peroperative ultrafiltration in obese, diabetic, recent MI, COPD and congestive heart failure patients; postoperatively less inotrope P0.0001, less diuretic requirement P0.0001, less colloidal fluid replacement p0.009, and relatively fewer minor complications. DISCUSSION AND CONCLUSION: Ultrafiltration to be applied during cardiopulmonary bypass in order to create a more balanced intravascular volume in patients with compensated renal failure, to reduce the need for volume expander fluid used for this purpose, to remove inflammation mediators that occur during cardiopulmonary bypass, and therefore to protect renal functions without the need for additional medication, especially COPD. We recommend it in the diabetic and obese patient group.

 INTRODUCTION: Preoperative renal dysfunction is one of the most important risk factors affecting postoperative morbidity and mortality in patients undergoing cardiac surgery. While patients with end-stage renal disease and dialysis-dependent constitute 1-3 of the renal failure spectrum, it should not be forgotten that coronary revascularization surgery is performed at a rate of 2-5 in the remaining asymptomatic majority. However, an optimal perioperative strategy has not been developed for this group of patients who have not yet undergone hemodialysis. In our study, conventional ultrafiltration was applied with a modified peroperative heart-lung machine and it was aimed to decrease mortality and morbidity. METHOD: 6303 patients who underwent coronary bypass surgery with the cardiopulmonary bypass technique between 2004 and 2011 at Başkent University Adana Hospitals were examined, and 99 patients with a preoperative serum creatinine level higher than 1.5 mgdl were included in this retrospective study. 99 patients were divided into two groups as UF performed 35 and not performed 64; They were evaluated in terms of drainage amounts, length of hospital stay, earlylate mortality and morbidity, and newly developing dialysis needs. RESULTS: There was no significant difference between the groups in terms of post-operative hemodialysis need, length of hospital stay and major complications. However; Peroperative ultrafiltration in obese, diabetic, recent MI, COPD and congestive heart failure patients; postoperatively less inotrope P0.0001, less diuretic requirement P0.0001, less colloidal fluid replacement p0.009, and relatively fewer minor complications. DISCUSSION AND CONCLUSION: Ultrafiltration to be applied during cardiopulmonary bypass in order to create a more balanced intravascular volume in patients with compensated renal failure, to reduce the need for volume expander fluid used for this purpose, to remove inflammation mediators that occur during cardiopulmonary bypass, and therefore to protect renal functions without the need for additional medication, especially COPD. We recommend it in the diabetic and obese patient group.

 GİRİŞ VE AMAÇ:Ameliyat öncesi böbrek fonksiyonlarındaki bozukluk, kalp cerrahisi uygulanan hastalarda, ameliyat sonrası morbidite ve mortaliteyi etkileyen en önemli risk faktörlerinden birisidir. Son dönem böbrek yetmezliği olan ve diyaliz bağımlı hastalar, böbrek yetmezliği spektrumunda 1-3lük dilimi oluştururken, geri kalan asemptomatik büyük çoğunlukta her yıl 2-5 oranında koroner revaskülarizasyon cerrahisine gidildiği unutulmamalıdır. Ancak henüz hemodiyalize girmemiş bu hasta grubu için optimal bir peroperatif strateji geliştirilememiştir. Çalışmamızda konvansiyonel ultrafiltrasyon, peroperatif kalp akciğer makinesine modifiye edilerek uygulanmış ve mortalite ve morbidite de azalma amaçlanmıştır. YÖNTEM:Başkent Üniversitesi Adana Hastanelerinde 2004-2011 yılları arasında kardiyopulmoner bypass tekniği ile koroner bypass ameliyatına alınan 10207 hasta incelenmiş, preoperatif serum kreatinin seviyesi 1,5mgdlden yüksek olan 99 hasta bu retrospektif çalışmaya dahil edilmiştir. 99 hasta UF yapılan 34 ve yapılmayan 65 olarak iki gruba ayrılmış; drenaj miktarları, hastane kalış süreleri, erkengeç dönem mortalite ve morbiditeleri ve yeni gelişen diyaliz ihtiyaçları yönünden değerlendirilmişlerdir. BULGULAR:Ameliyat sonrası hemodiyaliz ihtiyacı, hastanede kalış süresi ve major komplikasyonlar açısından gruplar arasında anlamlı fark saptanmadı. Ancak; obez, diyabetik, yeni MI geçiren, KOAHlı ve konjestif kalp yetmezliği bulunan olgularda peroperatif uygulanan ultrafiltrasyon; postoperatif daha az inotrop P0,0001, daha az diüretik P0,0001 ihtiyacı, daha az kolloidal mayi replasmanı p0,009 ve görece daha düşük minör komplikasyon ile seyretmiştir. TARTIŞMA VE SONUÇ:Kompanse böbrek yetmezlikli hastalarda daha dengeli intravasküler volüm oluşturabilmek, bu amaçla kullanılan volüm genişletici mayi gereksinimi azaltabilmek, kardiyopulmoner bypass esnasında ortaya çıkan inflamasyon mediatörlerini ortamdan uzaklaştırabilmek, dolayısı ile renal fonksiyonları ek medikasyona ihtiyaç duymadan koruyabilmek amacıyla kardiyopulmoner bypass esnasında uygulanacak ultrafiltrasyonu özellikle KOAHlı, diyabetik ve obez hasta grubunda önermekteyiz.

Makale detayları

A Technique for Reducing Coronary Bypass Morbidity in Patients with Compensated Renal Failure; Perioperative Ultrafiltration

Yazarlar:

Utku Alemdaroğlu | Öner Gülcan

Yayıncı:

Selcuk University

Ana Başlıklar:

Klinik Tıp Bilimleri

Dergi:

Genel Tıp Dergisi Vol.33 Issue 2, pp.142-147

Belge Tipi:

Makale

Yayın Tarihi:

4/2023

Belge Dili:

İngilizce

Document ID (Org No.):

2001288868

pISSN:

2602-3741

ultrafiltration

cabg

renal failureultrafiltrasyon

cabg

böbrek yetmezliği

Sayı

Makale detayları

A Technique for Reducing Coronary Bypass Morbidity in Patients with Compensated Renal Failure; Perioperative Ultrafiltration

Yazarlar: Utku Alemdaroğlu | Öner Gülcan

Yayıncı: Selcuk University

Ana Başlıklar: Klinik Tıp Bilimleri

Dergi: Genel Tıp Dergisi Vol.33 Issue 2, pp.142-147

Belge Tipi: Makale

Yayın Tarihi: 4/2023

Belge Dili: İngilizce

Document ID (Org No.): 2001288868

pISSN: 2602-3741

ultrafiltration

cabg

renal failureultrafiltrasyon

cabg

böbrek yetmezliği

Sayı

Yazarlar:

Utku Alemdaroğlu | Öner Gülcan

Yayıncı:

Selcuk University

Ana Başlıklar:

Klinik Tıp Bilimleri

Dergi:

Genel Tıp Dergisi Vol.33 Issue 2, pp.142-147

Belge Tipi:

Makale

Yayın Tarihi:

4/2023

Belge Dili:

İngilizce

Document ID (Org No.):

2001288868

pISSN:

2602-3741