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Pump assisted beating heart coronary bypass in patients with renal dysfunction: Can we prevent acute renal damage development?

Yıl 2021, Cilt: 12 Sayı: 1, 23 - 28, 31.03.2021
https://doi.org/10.18663/tjcl.893282

Öz

Aim: Different coronary bypass surgery techniques can be used to protect the kidneys in patients with impaired renal function. In conventional coronary artery bypass grafting technique, cardiopulmonary bypass (CPB) is established, hypothermia is performed, cardiac arrest is achieved by clamping the aorta. In the pump-assisted beating heart coronary bypass grafting technique, CPB is maintained for keeping the mean arterial pressure between certain levels. Hypothermia is avoided, aortic clamp and cardioplegia are not used. In this study, patients with impaired renal function were compared weather they had coronary artery bypass grafting in conventional or pump-assisted beating heart technique, in terms of acute renal damage and dialysis requirements in patients.
Material and Methods: Forty-eight patients who had coronary artery bypass graft surgery and whose serum creatinine level was higher than 1,3 mg / dl were included in the study. Twenty-four patients who underwent pump-assisted method were classified as Group I and 24 patients who underwent conventional method as Group II.
Results: There was no difference between the two groups in terms of renal function tests on preoperative evaluation. There were significant differences in urinary outputs before and during CPB, intensive care stays, acute renal damage and dialysis requirements (p <0.05). Four out of 24 patients in group I (16.66%) and 18 patients of 24 patients in group 2 (75%) had acute renal failure (ARD). In group I patient dialysis was not required and in group II eight patients required dialysis (p <0.05).
Conclusion: Different techniques have been developed due to increased mortality, morbidity and health expenditures in coronary artery bypass grafting in the presence of accompanying diseases. In our study, ARD and dialysis requirements were found to be higher by the conventional method in cases with serum creatinine level above 1.3 mg / dL. Pump-assisted beating heart coronary bypass surgery can be a good option in patients with high creatinine levels which we may encounter kidney problems in the postoperative period.

Kaynakça

  • 1. Thompson PD, Buchner D, Piña IL et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation 2003;107: 3109-3116.
  • 2. Ornish D, Brown SE, Billings JH et al. Can lifestyle changes reverse coronary heart disease? : The Lifestyle Heart Trial. The Lancet 1990; 336: 129-133.
  • 3. McFalls EO, Ward HB, Moritz TE et al. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med 2004; 351: 2795-2804.
  • 4. Kervan Ü, Koç O, Özatik MA ve ark. Türkiye’deki kalp damar cerrahisi kliniklerinin dağılımı ve hizmetlerinin niteliği. Turk Gogus Kalp Dama 2011; 19: 483-489.
  • 5. Hamulu A, Özbaran M, Atay Y, Pasacıoğlu H, Aras I, Buket S. Koroner bypass ameliyatında mortalite ve morbiditeye etki eden risk faktörlerinin belirlenmesi ve değerlendirilmesi. Turk Gogus Kalp Dama 1995; 3: 11-16.
  • 6. Oğuş T, İpek G, Işık Ö, Berki T, Gürbüz A, Balkanay B. Yüksek risk taşıyan hastalarda kalp-akciğer makinası kullanılmaksızın çalışan kalpte koroner bypass yöntemi. Turk Gogus Kalp Dama 1996; 4: 9-14.
  • 7. Şener T, Köprülü AŞ, Karpuzoğlu OE, Acar L, Temur B, Gerçekoğlu H. Kronik böbrek disfonksiyonu olan hastalarda atan kalpte koroner arter baypas cerrahisinin klinik sonuçları. Turk Gogus Kalp Dama 2013; 21: 918-923.
  • 8. Fındık O, Haberal İ, Akyıldız M ve ark. EuroSCORE, Cleveland ve CABDEAL klinik risk sınıflama sistemlerinin Türk toplumu için duyarlılık ve özgüllüklerinin karşılaştırılması. Turk Gogus Kalp Dama 2012; 20: 458-466.
  • 9. Bahar I, Akgul A, Ozatik ME et al. Acute renal failure following open heart surgery: risk factors and prognosis. Perfusion 2005; 20: 317-22.
  • 10. Metha RH, Honeycutt E, Patel UD et al. Relationship of the time interval between cardiac catheterization and elective coronary artery surgery with postprocedural acute kidney injury. Circulation 2011; 124: 149-155.
  • 11. Mangano CM, Diamondstone LS, Ramsay JG, Aggarwal A, Hersko A, Mangano DT. Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. Multicenter Study of Perioperative Ischemia Research Group. Ann Intern Med. 1998; 128:194–203.
  • 12. Dasta JF, Kane-Gill SL, Durtschi AJ, Pathak DS, Kellum JA. Cost and outcomes of acute kidney injury following cardiac surgery. Nephrol Dial Transplant 2008; 23: 1970- 4.
  • 13. Rosner MH, Okusa MD: Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol 2006; 1: 19-32.
  • 14. Lassnigg A, Schmidlin D, Mouhieddine M, Bachman LM, Druml W, Bauer P. Minimal changes of serum creatinine predict prognosis in patient after cardiothoracic surgery: A prospective cohort study. J Am Soc Nephrol 2004; 15: 1597-1605.
  • 15. Thakar CV, Liangos O, Yared JP et al. ARF after open heart surgery: Influence of gender and race. Am J Kidney Dis 2003; 41: 742-51.
  • 16. Karkouti K, Wijeysundera DN, Yau TM et al. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation 2009; 119: 495–502.
  • 17. Park M, Coca SG, Nigwekar SU et al. Prevention and treatment of acute kidney injury in patients undergoing cardiac surgery: a systematic review. Am J Nephrol 2010; 31: 408–18.
  • 18. Karkouti K, Beattie WS, Wijeysundera DN et al. Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery. J Thorac Cardiovasc Surg 2005; 129: 391-400.
  • 19. Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: Pathophysiology and treatment: An update. Eur J Cardiothorac Surg 2002; 21: 232-244.
  • 20. Chukwuemeka A, Weisel A, Maganti M et al. Renal dysfunction in high-risk patients after on-pump and off-pump coronary artery bypass surgery: A propensity score analysis. Ann Thorac Surg 2005; 80: 2148-2153.
  • 21. Seabra VF, Alobaidi S, Balk EM, Poon AH, Jaber BL. Off-pump coronary artery bypass surgery and acute kidney injury: A meta-analysis of randomized controlled trials. Clin J Am Soc Nephrol 2010; 5: 1734-1744.
  • 22. Palomba H, De Castro I, Neto ALC, Lage S, Yu L. Acute kidney injury prediction following elective cardiac surgery: AKICS score. Kidney Int 2007; 72: 624-31.
  • 23. Kumar AB, Suneja M. Cardiopulmonary bypass-associated acute kidney injury. Anesthesiology 2011; 114: 964-970.
  • 24. Salis S, Mazzanti VV, Merli G et al. Cardiopulmonary bypass duration is an independent predictor of mortality and morbidity after cardiac surgery. J Cardiothorac Vasc Anesth 2008; 22: 814–22.

Böbrek fonksiyonu bozuk hastalarda pompa destekli atan kalpte koroner bypass: Akut renal hasar gelişimini önleyebilir miyiz?

Yıl 2021, Cilt: 12 Sayı: 1, 23 - 28, 31.03.2021
https://doi.org/10.18663/tjcl.893282

Öz

Amaç: Böbrek fonksiyonları bozuk olan olgularda böbrekleri korumak amacı ile farklı koroner bypass ameliyatı teknikleri kullanılabilir. Konvansiyonel koroner arter bypass greftleme tekniğinde kardiyopulmoner bypassa (KPB) girilerek, hipotermi uygulanmakta, aorta klemplenerek kardiyopleji ile kardiyak arrest sağlanmaktadir. Pompa destekli atan kalpte bypass greftleme tekniğinde ise ortalama arteriyel basıncı belli düzeyde tutmak amacıyla ihtiyaç duyulması halinde KPB’a girilmektedir. Hipotermiden kaçınılmakta, aorta klempi ve kardiyopleji kullanılmamaktadır. Bu çalışmamızda, böbrek fonksiyonları bozuk olan olgularda, konvansiyonel yöntem ile pompa destekli atan kalpte yapılan koroner bypass ameliyatı olan hastalarda gelişen akut renal hasarlanma ve diyaliz gereksinimi açısından karşılaştırdık.
Gereç ve Yöntemler: Klinigimizde 3 yıl içerisinde koroner arter hastalığı nedeniyle izole koroner arter bypass greft cerrahisi uygulanan ve serum kreatinin düzeyi 1,3 mg/dl’den yüksek olan 48 olgu çalışmaya dahil edildi. Atan kalpte pompa destekli yöntem uygulanan 24 olgu Grup I, konvansiyonel yöntem uygulanan 24 olgu Grup II olarak kabul edildi.
Bulgular: Preoperatif değerlendirmede böbrek fonksiyon testleri açısından her iki grup arasında farklılık yoktu. KPB öncesi ve KPB esnasında idrar outputları, yoğun bakım kalış süreleri, akut renal hasarlanma ve diyaliz gereksinimleri açısından anlamlı farklılık saptandı (p<0.05). Grup I’ de 24 olgunun dördünde (%16,66); Grup 2’de ise 24 olgunun 18’ inde (%75) akut böbrek hasarı saptandı. Grup I olgularında diyaliz ihtiyacı saptanmazken, Grup II’ de sekiz hastada diyaliz ihtiyacı olduğu görüldü (p<0.05).
Sonuç: Eşlik eden hastalıkların varlığında koroner arter bypass greftleme de mortalite, morbidite ve sağlık harcamalarının artması sebebi ile farklı teknikler geliştirilmektedir. Çalışmamızda serum kreatinin düzeyi 1,3 mg/dl’nin üzerinde olan olgularda ABH ve diyaliz ihtiyaçları konvansiyonel yöntem ile daha fazla olduğu tespit edilmiştir. Kreatinin seviyeleri yüksek olan ve ameliyat sonrası dönemde böbrek problemleri ile karşılaşabileceğimizi düşündüğümüz olgularda pompa destekli atan kalpte bypass ameliyatı iyi bir seçenek olabilir.

Kaynakça

  • 1. Thompson PD, Buchner D, Piña IL et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation 2003;107: 3109-3116.
  • 2. Ornish D, Brown SE, Billings JH et al. Can lifestyle changes reverse coronary heart disease? : The Lifestyle Heart Trial. The Lancet 1990; 336: 129-133.
  • 3. McFalls EO, Ward HB, Moritz TE et al. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med 2004; 351: 2795-2804.
  • 4. Kervan Ü, Koç O, Özatik MA ve ark. Türkiye’deki kalp damar cerrahisi kliniklerinin dağılımı ve hizmetlerinin niteliği. Turk Gogus Kalp Dama 2011; 19: 483-489.
  • 5. Hamulu A, Özbaran M, Atay Y, Pasacıoğlu H, Aras I, Buket S. Koroner bypass ameliyatında mortalite ve morbiditeye etki eden risk faktörlerinin belirlenmesi ve değerlendirilmesi. Turk Gogus Kalp Dama 1995; 3: 11-16.
  • 6. Oğuş T, İpek G, Işık Ö, Berki T, Gürbüz A, Balkanay B. Yüksek risk taşıyan hastalarda kalp-akciğer makinası kullanılmaksızın çalışan kalpte koroner bypass yöntemi. Turk Gogus Kalp Dama 1996; 4: 9-14.
  • 7. Şener T, Köprülü AŞ, Karpuzoğlu OE, Acar L, Temur B, Gerçekoğlu H. Kronik böbrek disfonksiyonu olan hastalarda atan kalpte koroner arter baypas cerrahisinin klinik sonuçları. Turk Gogus Kalp Dama 2013; 21: 918-923.
  • 8. Fındık O, Haberal İ, Akyıldız M ve ark. EuroSCORE, Cleveland ve CABDEAL klinik risk sınıflama sistemlerinin Türk toplumu için duyarlılık ve özgüllüklerinin karşılaştırılması. Turk Gogus Kalp Dama 2012; 20: 458-466.
  • 9. Bahar I, Akgul A, Ozatik ME et al. Acute renal failure following open heart surgery: risk factors and prognosis. Perfusion 2005; 20: 317-22.
  • 10. Metha RH, Honeycutt E, Patel UD et al. Relationship of the time interval between cardiac catheterization and elective coronary artery surgery with postprocedural acute kidney injury. Circulation 2011; 124: 149-155.
  • 11. Mangano CM, Diamondstone LS, Ramsay JG, Aggarwal A, Hersko A, Mangano DT. Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. Multicenter Study of Perioperative Ischemia Research Group. Ann Intern Med. 1998; 128:194–203.
  • 12. Dasta JF, Kane-Gill SL, Durtschi AJ, Pathak DS, Kellum JA. Cost and outcomes of acute kidney injury following cardiac surgery. Nephrol Dial Transplant 2008; 23: 1970- 4.
  • 13. Rosner MH, Okusa MD: Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol 2006; 1: 19-32.
  • 14. Lassnigg A, Schmidlin D, Mouhieddine M, Bachman LM, Druml W, Bauer P. Minimal changes of serum creatinine predict prognosis in patient after cardiothoracic surgery: A prospective cohort study. J Am Soc Nephrol 2004; 15: 1597-1605.
  • 15. Thakar CV, Liangos O, Yared JP et al. ARF after open heart surgery: Influence of gender and race. Am J Kidney Dis 2003; 41: 742-51.
  • 16. Karkouti K, Wijeysundera DN, Yau TM et al. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation 2009; 119: 495–502.
  • 17. Park M, Coca SG, Nigwekar SU et al. Prevention and treatment of acute kidney injury in patients undergoing cardiac surgery: a systematic review. Am J Nephrol 2010; 31: 408–18.
  • 18. Karkouti K, Beattie WS, Wijeysundera DN et al. Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery. J Thorac Cardiovasc Surg 2005; 129: 391-400.
  • 19. Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: Pathophysiology and treatment: An update. Eur J Cardiothorac Surg 2002; 21: 232-244.
  • 20. Chukwuemeka A, Weisel A, Maganti M et al. Renal dysfunction in high-risk patients after on-pump and off-pump coronary artery bypass surgery: A propensity score analysis. Ann Thorac Surg 2005; 80: 2148-2153.
  • 21. Seabra VF, Alobaidi S, Balk EM, Poon AH, Jaber BL. Off-pump coronary artery bypass surgery and acute kidney injury: A meta-analysis of randomized controlled trials. Clin J Am Soc Nephrol 2010; 5: 1734-1744.
  • 22. Palomba H, De Castro I, Neto ALC, Lage S, Yu L. Acute kidney injury prediction following elective cardiac surgery: AKICS score. Kidney Int 2007; 72: 624-31.
  • 23. Kumar AB, Suneja M. Cardiopulmonary bypass-associated acute kidney injury. Anesthesiology 2011; 114: 964-970.
  • 24. Salis S, Mazzanti VV, Merli G et al. Cardiopulmonary bypass duration is an independent predictor of mortality and morbidity after cardiac surgery. J Cardiothorac Vasc Anesth 2008; 22: 814–22.
Toplam 24 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Özgün Makale
Yazarlar

Özgür Ersoy Bu kişi benim

Deniz Sartp Beyazpınar Bu kişi benim

Eren Günertem

Yayımlanma Tarihi 31 Mart 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 12 Sayı: 1

Kaynak Göster

APA Ersoy, Ö., Beyazpınar, D. S., & Günertem, E. (2021). Böbrek fonksiyonu bozuk hastalarda pompa destekli atan kalpte koroner bypass: Akut renal hasar gelişimini önleyebilir miyiz?. Turkish Journal of Clinics and Laboratory, 12(1), 23-28. https://doi.org/10.18663/tjcl.893282
AMA Ersoy Ö, Beyazpınar DS, Günertem E. Böbrek fonksiyonu bozuk hastalarda pompa destekli atan kalpte koroner bypass: Akut renal hasar gelişimini önleyebilir miyiz?. TJCL. Mart 2021;12(1):23-28. doi:10.18663/tjcl.893282
Chicago Ersoy, Özgür, Deniz Sartp Beyazpınar, ve Eren Günertem. “Böbrek Fonksiyonu Bozuk Hastalarda Pompa Destekli Atan Kalpte Koroner Bypass: Akut Renal Hasar gelişimini önleyebilir Miyiz?”. Turkish Journal of Clinics and Laboratory 12, sy. 1 (Mart 2021): 23-28. https://doi.org/10.18663/tjcl.893282.
EndNote Ersoy Ö, Beyazpınar DS, Günertem E (01 Mart 2021) Böbrek fonksiyonu bozuk hastalarda pompa destekli atan kalpte koroner bypass: Akut renal hasar gelişimini önleyebilir miyiz?. Turkish Journal of Clinics and Laboratory 12 1 23–28.
IEEE Ö. Ersoy, D. S. Beyazpınar, ve E. Günertem, “Böbrek fonksiyonu bozuk hastalarda pompa destekli atan kalpte koroner bypass: Akut renal hasar gelişimini önleyebilir miyiz?”, TJCL, c. 12, sy. 1, ss. 23–28, 2021, doi: 10.18663/tjcl.893282.
ISNAD Ersoy, Özgür vd. “Böbrek Fonksiyonu Bozuk Hastalarda Pompa Destekli Atan Kalpte Koroner Bypass: Akut Renal Hasar gelişimini önleyebilir Miyiz?”. Turkish Journal of Clinics and Laboratory 12/1 (Mart 2021), 23-28. https://doi.org/10.18663/tjcl.893282.
JAMA Ersoy Ö, Beyazpınar DS, Günertem E. Böbrek fonksiyonu bozuk hastalarda pompa destekli atan kalpte koroner bypass: Akut renal hasar gelişimini önleyebilir miyiz?. TJCL. 2021;12:23–28.
MLA Ersoy, Özgür vd. “Böbrek Fonksiyonu Bozuk Hastalarda Pompa Destekli Atan Kalpte Koroner Bypass: Akut Renal Hasar gelişimini önleyebilir Miyiz?”. Turkish Journal of Clinics and Laboratory, c. 12, sy. 1, 2021, ss. 23-28, doi:10.18663/tjcl.893282.
Vancouver Ersoy Ö, Beyazpınar DS, Günertem E. Böbrek fonksiyonu bozuk hastalarda pompa destekli atan kalpte koroner bypass: Akut renal hasar gelişimini önleyebilir miyiz?. TJCL. 2021;12(1):23-8.


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