Effect of cardiopulmonary bypass on the development of acute kidney injury after open-heart surgery

2020 ◽  
Vol 24 (4) ◽  
pp. 37-45
Author(s):  
Yu. S. Polushin ◽  
D. V. Sokolov ◽  
N. S. Molchan ◽  
R. V. Akmalova
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
General Anesthesia ◽  
Postoperative Period ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Kidney Injury ◽  
Open Heart ◽  
Stage 1

THE AIM. Assessment of factors associated with cardiopulmonary bypass (CPB) in acute renal dysfunction in patients in the early postoperative period after cardiac surgery. PATIENTS AND METHODS. Monocentric observational study in patients (n = 97) who underwent elective open-heart cardiac surgery (coronary artery bypass grafting -50.44 %, aortic valve prosthetics – 31.04 %, mitral valve prosthetics – 12.61 %) using cardiopulmonary bypass. Inclusion criteria: the study included patients not younger than 18 years old, undergoing cardiac surgery with CPB lasting up to 95 minutes (coronary bypass surgery, valve replacement), without signs of end-stage renal disease. Using nonparametric correlation analysis, we evaluated the effect on the development of acute kidney injury (AKI) of the following extracorporeal circulation factors: duration of CPB, aortic cross-clamp, mean arterial pressure (MAP), cardiac index (CI), perfusion flow rate (PFR), transport, consumption, and oxygen extraction variables. The diagnosis of AKI was made on the basis of the KDIGO classification, the studied parameters were recorded initially (before the operation), 15 minutes after the start of general anesthesia, 30 minutes after the start of cardiopulmonary bypass and 15 minutes after the end of general anesthesia. RESULTS. The frequency of AKI in 24 hours after surgery was 56.3 % (58 cases): including stage 1 in 37 (35.9 %), stage 2 in 17 (16.5 %) , stage 3 – in 4 (3.9 %) patients. In the 48th hour of the postoperative period, signs of AKI regressed and were presented in only 26 people (25.2 %), including the stage 1 in 18 (17.5 %), the stage 2 – in 5 (4.8 %), stage 3 – in 3 (2.9 %). Among the risk factors for AKI in cardiac surgery with CPB, the main effect of the anemia was revealed, especially a decrease in hemoglobin levels of less than 90 g / l and hematocrit of less than 25 %. CONCLUSION. Hemodilution below the "threshold" values of hemoglobin and hematocrit during the CPB provoke acute kidney injury in patients undergoing open-heart surgery.

scholarly journals P0115EFFECT OF CARDIOPULMONARY BYPASS ON THE DEVELOPMENT OF ACUTE KIDNEY INJURY AFTER OPEN-HEARD SURGERY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nikolai Molchan ◽  
Regina Akmalova ◽  
Dmitriy Sokolov ◽  
Olga Galkina ◽  
Yuri Polushin ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
General Anesthesia ◽  
Postoperative Period ◽  
Kidney Injury ◽  
Open Heart ◽  
Acute Renal Dysfunction ◽  
Stage 1 ◽  
Nonparametric Correlation

Abstract Background and Aims Assessment of factors associated with cardiopulmonary bypass (CPB) in acute renal dysfunction in patients in the early postoperative period after cardiac surgery. Method Monocentric observational study in patients (n = 97) who underwent elective open-heart cardiac surgery (coronary artery bypass grafting -50.44%, aortic valve prosthetics - 31.04%, mitral valve prosthetics - 12.61%) using cardiopulmonary bypass. Inclusion criteria: the study included patients not younger than 18 years old, undergoing cardiac surgery with CPB lasting up to 95 minutes (coronary bypass surgery, valve replacement), without signs of end-stage chronic kidney disease (CKD). Using nonparametric correlation analysis, we evaluated the effect on the development of acute kidney injury (AKI) of the following extracorporeal circulation factors: duration of CPB, aortic cross-clamp, mean arterial pressure (MAP), cardiac index (CI), perfusion flow rate (PFR), transport, consumption and oxygen extraction variables. The diagnosis of AKI was made on the basis of the KDIGO classification, the studied parameters were recorded initially (before the operation), 15 minutes after the start of general anesthesia, 30 minutes after the start of cardiopulmonary bypass and 15 minutes after the end of general anesthesia. Results The frequency of AKI in 24 hours after surgery was 56.3% (58 cases): including stage 1 in 37 (35.9%), stage 2 in 17 (16.5%), stage 3 - in 4 (3.9%) patients. In the 48th hour of the postoperative period signs of AKI regressed, and were presented in only 26 people (25.2%), including the stage 1 in 18 (17.5%), the stage 2 - in 5 (4.8%), stage 3 - in 3 (2.9%). Among the risk factors for AKI in cardiac surgery with CPB, the main effect of of the anemia was revealed, especially a decrease in hemoglobin levels of less than 90 g / l and hematocrit of less than 25%. Conclusion Hemodilution below the "threshold" values of hemoglobin and hematocrit during the CPB provoke acute kidney injury in patients undergoing open-heart surgery.

scholarly journals The Relation Of Intraoperative Renal Oxygen Saturation Change With Postoperative Acute Kidney Injury

2021 ◽  
Author(s):  
Mustafa Emre Gürcü ◽  
Atakan Erkılınç ◽  
Pınar Karaca Baysal ◽  
Fatih Yılmaz ◽  
Tuncer Koçak
Keyword(s):  
Acute Kidney Injury ◽  
Cardiopulmonary Bypass ◽  
Oxygen Saturation ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Kidney Injury ◽  
Left Ventricular Ejection ◽  
Open Heart ◽  
The Relationship ◽  
Renal Oxygen

Objective: Acute kidney injury seen in 25-30 % of the cases after open heart surgery where cardiopulmonary bypass was performed, is one of the most important factors that affect the success of the on- pump open heart surgery by increasing the rates of postoperative morbidity, and mortality. Near infrared spectroscopy (NIRS) is a noninvasive monitoring that frequently used method that allows correction of imbalances in oxygen supply to the brain and vital organs. We aimed to investigate the relationship between renal oxygen saturation values and postoperative acute kidney injury. Method: Fifty patients who underwent on- pump open heart surgery between July 2020 and January 2021 by using cardiopulmonary bypass were included in the study. Demographic data included age, gender, body mass index (BMI), hypertension, diabetes mellitus, chronic obstructive pulmonary disease, other chronic diseases and left ventricular ejection fraction. The definition of acute kidney injury was defined according to the criteria of KDIGO. At the end of the postoperative 48th hour the relationship between intraoperative renal rSO2 changes in patients with or without acute kidney injury was evaluated. Results: Fifty patients were included in the current study. The median (IQR) age of 50 patients was 62 (54.3-66.5), and mostly male patients constituted the study populatio,. When we evaluated the intraoperative data, there were statistically significant differences in changes in renal rSO2 values in patients who had and had not developed postoperative acute kidney injury (-12%, -3%, respectively) (p: 0.001). In the multivariate logistic regression analysis, the change in rSO2 values in the intraoperative period [(from - 10% to 0.5%), OR: 0.18 (0.04-0.76) p: 0.03] were found to be an independent predictor of postoperative acute kidney injury. Conclusion: We found that the decrease of renal rSO2 measurements during surgery may predict the development of acute kidney injury in the postoperative period. We think that renal oxygen saturation monitoring with NIRS is a very effective method for predicting postoperative renal dysfunction, because it is both noninvasive and reflects simultaneous data.

scholarly journals Open Heart Surgery Associated Acute Kidney Injury in Children

2013 ◽  
Vol 13 (2) ◽  
pp. 37-42
Author(s):  
Jekabs Krastins ◽  
Zane Straume ◽  
Janis Auzins ◽  
Aigars Petersons ◽  
Aivars Petersons
Keyword(s):  
Acute Kidney Injury ◽  
Cardiopulmonary Bypass ◽  
Urine Output ◽  
Heart Surgery ◽  
Tertiary Care ◽  
Open Heart Surgery ◽  
Kidney Injury ◽  
Open Heart ◽  
Significant Difference ◽  
Hospital Pediatric

Abstract Introduction. Cardiac surgery with cardiopulmonary bypass (CPB) is commonly perceived as a risk factor for decline in renal function. Hypothermia, hypoxia, hypotension, non-pulsatile blood flow during CPB, use of ACE inhibitors, inotropic and (or) vasoactive support affects kidney and contributes to the acute kidney injury (AKI). Aim of the study. The purpose of this study was to evaluate the incidence, severity and outcome of CPB related AKI in children after open heart surgery. Materials and methods. We conducted prospective, non-randomized observational study at the tertiary care University Children’s Hospital Pediatric ICU. We enrolled 30 patients, 12 boys and 18 girls with congenital heart disease (CHD). Their median body weight was 6,8 kg, (IQR 5,2<8,2 kg) and median age 7 months (IQR 5<10 months). SCr was determined and preoperative and postoperative creatinine clearance (ClCr) was estimated using Schwarz formula (eClCr). During surgical repair and till the end of the first 12 postoperative hours urine was collected to measure ClCr, using the difference in urine (UCr) and SCr concentrations (mClCr). Urine output, body temperature, duration of aortic cross clamping and cardiopulmonary bypass was recorded. Results. Median intraoperative urine output was 2,4 ml/kg/h (IQR 1,29<3,15 ml/kg/h). Median CPB time was 147 min., (IQR 116,75<205 min.), median aortic cross-clamping time was 95 min., (IQR 70,5<133 min.), cooling during CPB to 29,75°C. Postoperative SCr increased to 35 μmol/l (IQR 27,5<50,5 μmol/l) vs. preoperative SCr 29 μmol/l (IQR 24<32,9 μmol/l), P<0,0001. GFR declined from preoperative 98,4 ml/min./1,73 m2 (IQR 89,6<123,04) to postoperative 80,98 ml/min./1,73 m2, (IQR 60,73<97,97 ml/min./1,73 m2), P<0,0001. We find statistically significant difference (P=0,042) in measured 39,88 ml/min./1,73 m2 (IQR 21,96<67,82 ml/min./1,73 m2) versus estimated ClCr (eClCr) 80,98 ml/min./1,73 m2, (IQR 60,73<97,97 ml/min./1,73 m2). Observed prevalence of AKI was 46,6% (14/30 patients met KDIGO criteria for AKI). Conclusions.Open heart surgery in children has severe, but transient effect on expression of renal biomarkers. There was a marked difference between measured and estimated ClCr in our patients. Observed incidence of AKI was 46,6% (14 patients met KDIGO criteria of AKI from 30 of our patients). Before discharge from the hospital both biomarkers returned to normal values.

scholarly journals Pre-operative and peri operative predictors of acute renal failure after cardiac surgery

2019 ◽  
Vol 6 (3) ◽  
pp. 756
Author(s):  
Praveen Dhaulta ◽  
Vikas Panwar
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Ejection Fraction ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Clinical Variable ◽  
Open Heart ◽  
Multiple Variables

Background: Acute kidney injury (AKI) is one of the most serious complications during the postoperative period of cardiac surgery. Multiple variables predict the ARF after cardiac surgery. Objective of this study was to evaluate the significance of pre and peri-operative variables which may help in predicting the chances of developing ARF after cardiac surgery.Methods: This study was an observational, prospective study conducted among patients who were scheduled to undergo open heart surgery under cardiopulmonary bypass.Results: In total, 50 patients who underwent open-heart surgery, ARF was seen in 5 patients, with the incidence rate of 10%. Acute renal failure was present in one patient with ejection fraction <35, 2 patients had ejection fraction between 35 to 50 and 2 patients with ejection fraction >50. It was seen in 4 patients with 1-2 hrs of cardiopulmonary bypass and in 1 patient with >2 hrs of cardiopulmonary bypass. ARF was also seen in 4 patients with hematocrit between 22-26% and in 1 patient with >26%.Conclusions: The study provided a clinical variable score that can predict ARF after open-heart surgery. The score enhances the accuracy of prediction by accounting for the effect of all major risk factors of ARF.

Preoperative Albumin Level is not Associated with Acute Kidney Injury After Pediatric Cardiac Surgery: A Retrospective Cohort

2021 ◽  
Author(s):  
Fatma Ukil Isildak ◽  
Yasemin Yavuz ◽  
Omer Faruk Savluk ◽  
Nihat Cine ◽  
Ufuk Uslu
Keyword(s):  
Acute Kidney Injury ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Retrospective Cohort ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Kidney Injury ◽  
Open Heart ◽  
Preoperative Albumin

Objectives: This study aimed to evaluate whether the development of acute kidney injury (AKI) was associated with preoperative albumin/prealbumin levels and other clinical features in pediatric patients who underwent open-heart surgery for congenital heart disease. Patients and Methods: In this retrospective cohort, patients aged between 1 – 60 months who underwent open-heart surgery (complete correction surgery) with a diagnosis of congenital heart disease at the XXXXXX, between January 1, 2018 - December 31, 2020, were retrospectively included (n = 100). Patient demographics, diagnoses, surgical characteristics, and laboratory findings were recorded and analyzed. Results: Mean age was 13.63 ± 12.05 (range 1.5 - 60) months. eGFR was decreased by more than 50% in 13% of the cases. Compared to the preoperative period, it was found that urea (24th and 48th hour) and creatinine levels increased significantly (p< 0.001, for each), and eGFR decreased significantly in the postoperative period (p< 0.001). Linear regression for eGFR value revealed that longer aortic cross-clamp time (ACCT) was associated with a greater decrease in eGFR (p= 0.046). Other variables included in the model, age (p= 0.128), gender (p= 0.358), RACHS (p= 0.865), body mass index (p= 0.862), prealbumin (p= 0.313), albumin (p= 0.806) and duration of cardiopulmonary bypass (p= 0.921) were found to be non-significant. Conclusion: While there was no relationship between eGFR and preoperative albumin/prealbumin levels in patients who underwent cardiac surgery due to congenital heart disease, longer ACCT was found to be associated with decreased eGFR.

scholarly journals Impact of some intraoperative factors on wound infection in cardiac surgery

2021 ◽  
Vol 20 (1) ◽  
pp. 36-43
Author(s):  
A. V. Stepin
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Wound Infection ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Wound Infections ◽  
Open Heart ◽  
Postoperative Wound ◽  
Sternal Infection ◽  
Mammary Arteries

Relevanc. Surgical Site Infection (SSI) after open heart surgery is a significant problem in clinical, social, and economic aspect which causes the need to identification of the preferred procedures for successful prevention of the SSI.Objectives. To determine risk of the SSI in cardiac surgery depending on complexity of intervention, using of cardiopulmonary bypass (CBP) and use of both internal mammary arteries (IMA).Methods. Prospective observations study from 2010 to 2019 in cardiac surgery department of the Ural Institute of Cardiology, where in total 4993 open heart surgery procedures were consecutively performed. All SSI cases were recorded up to 90 days after surgery. The analysis was performed to identify risk of cardiopulmonary bypass (CPB), bilateral IMA grafting and combined procedures on the risk of the postoperative wound infection.Results. During the investigation period, total 220 cases of the SSI (4,5%) have been registered of the 4993 patients undergoing open heart surgery. It included 42 cases of deep sternal infection (0,9%) and 178 cases of superficial infection (3,6%). The main pathogen identified was Staphylococcus epidermidis (56,4%). During the hospital period, 151 cases (66,5%) of SSI have been detected, with the median time to detection of the complication 6 days. The relative mortality risk in deep sternal infection group was 4,4 times higher than in the group without SSI (HR 4,6, 95 % CI 1,5-13,9, p=0,003624). CABG increases the relative risk of SSI in compare with non-CABG procedures (OR 3,086169; 95%CI 1,281 – 7,437), while the complexity of the operation (combined versus isolated interventions) does not significantly increase the risk (OR 0.972283; 95% CI: 0.696 - 1.359). The incidence of SSI in the group of in situ BIMA grafting was 8.8%, significantly increasing the likelihood of the SSI in compare to those with SIMA (OR 2.167983, 95% CI 1.463 - 3.212; p =0,000057). CBP significantly increases the risk of postoperative wound infections (OR 1.523890, 95% CI 1.149 - 2.022, p = 0.001742).Conclusions. Refusal of cardiopulmonary bypass, simultaneous procedures and bilateral coronary artery bypass does not allow completely to avoid postoperative wound infections. Nevertheless, the technical features of the preparations and use of grafts, including skeletonization, prevention of coagulation and the preference for sequential composite CABG, can reduce the risk associated with the type of the open heart surgery.

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