Cardiovascular Surgery with Cardiopulmonary Bypass in Patients with Preoperative Non-dialysis Dependent Renal Insufficiency.
BACKGROUND
Preoperative renal insufficiency is a predictor of acute renal injury in patients undergoing cardiovascular surgery with cardiopulmonary bypass.


METHODS
From January 2010 to September 2012, 121 patients undergoing coronary bypass, valve replacement, or both were included in our retrospective study, using cardiopulmonary bypass. We compared the changes in renal function and clinical outcomes of 66 patients with a baseline serum creatinine level more than 1.5 mg/dL with 55 patients with normal serum creatinine levels. We analyzed the impact of cardiopulmonary bypass in patients with non-dialysis dependent renal insufficiency.


RESULTS
In the group of patients with preoperative renal injury, the need for dialysis was greater, time of mechanical ventilation longer, and daily diuresis lesser compared with the group of patients with normal serum creatinine levels. Other clinical outcomes such as postoperative hemodynamic problems and organ dysfunction were similar. Prolonged time of cardiopulmonary bypass and cross-clamp affected postoperative renal injury. The study also showed intraoperative dopamine infusion at renal dose and ultrafiltration are not effective with protecting renal tubular function. Serum creatinine levels and glomerular filtration rate (GFR) were found to be useful parameters for renal injury.


CONCLUSIONS
These results demonstrate the safety and trustworthiness of cardiopulmonary bypass in patients with non-dialysis dependent renal insufficiency.
Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Temur
T
Bahar
Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Mehmet
M
Kaplan
Department of Cardiovascular Surgery, Gaziyasargil Training and Research Hospital, Diyarbakır, Turkey.
Yilmaz
Y
Muruvvet
Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Selcuk Ummuhan
SU
Nehir
Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Can
C
Tolga
Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Olsun
O
Adlan
Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Aydogan
A
Hakkı
D002315:Cardiopulmonary Bypass / Q000706:statistics & numerical data*; D013504:Cardiovascular Surgical Procedures / Q000706:statistics & numerical data*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011300:Preoperative Care / Q000379:methods; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D051437:Renal Insufficiency / Q000453:epidemiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D014421:Turkey / Q000453:epidemiology