Rıza TÜRKÖZ, Öner GÜLCAN, Orhan Saim DEMİRTÜRK, Hüsyin Ali TÜNEL, İsa COŞKUN

Ameliyat öncesi kompanse böbrek yetmezlikli hastalarda kardiyopulmoner bypass altında ve çalışan kalpte koroner revaskülarizasyon

Amaç: Bu geriye dönük çalışmada, kardiyopulmoner bypass (KPB) ve çalışan kalp (ÇK) yöntemleri kullanılarak koroner revaskülarizasyon uygulanan kompanse böbrek yetmezlikli (KOBY) hastaların böbrek fonksiyonları ve ameliyat sonrası sonuçları değerlendirildi. Çalışma planı: Ocak 2001 - Mayıs 2008 tarihleri arasında koroner revaskülarizasyon yapılan KOBY'li 58 hasta çalışmaya alındı. Hastalar, revaskülarizasyon yöntemine göre iki gruba ayrıldı: KPB ile ameliyat edilen hastalar (grup 1; n=45, ort. yaş 64±9.2 yıl) ve ÇK ile ameliyat edilen hastalar (grup 2; n=13, ort. yaş 66.5±7.9 yıl). İki grup, demografik özellikler, ameliyat öncesi, ameliyat sonrası ve taburcu günündeki böbrek fonksiyonları, hemodiyaliz gereksinimleri ile erken ve orta dönem sonuçları açısından karşılaştırıldı.Bulgular: Grupların demografik özellikleri birbirine benzerdi. Ameliyat sonrası diüretik, inotrop, intra-aortik balon pompası gereksinimi, hemodiyaliz, kanama nedeniyle revizyon gereksinimi, ameliyat sonrası komplikasyonlar veya hastane içi ve geç dönem mortaliteleri açısından hastalarda anlamlı fark saptanmadı (p>0.05). Ameliyat sonrası ve taburcu günü BUN ve kreatinin değerleri açısından gruplar arasında istatistiksel olarak anlamlı bir fark yoktu (p>0.05). Ortalama takip süresi 44.3±30.4 ay idi. Takip periyodunda, kalıcı hemodiyaliz gereksinimi grup 2'de anlamlı şekilde daha yüksek idi (p

Off-pump and on-pump coronary revascularization in preoperatively compensated renal failure patients

Background: In this retrospective study, renal functions and postoperative results in patients with compensated renal failure (CRF) undergoing coronary revascularization using cardiopulmonary bypass (CPB) or beating heart (BH) methods have been evaluated. Methods: Fifty-eight patients with CRF who underwent coronary revascularization between January 2001 and May 2008 were included in the study. The patients were divided into two groups according to the method of revascularization; the patients operated with CPB (group 1 n=45, mean age 64±9.2 years) and the patients operated with BH (group 2; n=13, mean age 66.5±7.9 years). The two groups were compared with respect to demographic characteristics, preoperative, postoperative and discharge day renal functions, hemodialysis requirements and early and mid-term results.Results: The demographic characteristics were similar in both groups. No statistically significant differences were found in the patients with respect to postoperative diuretic use, inotropes, need of intraaortic balloon pump, hemodialysis, requirement for revision due to bleeding, postoperative complications or in-hospital and late mortalities (p

PDF

___

1) Edwards FH, Clark RE, Schwartz M. Coronary artery bypass grafting: the Society of Thoracic Surgeons National Database experience. Ann Thorac Surg 1994;57:12-9.
2) Higgins TL, Estafanous FG, Loop FD, Beck GJ, Blum JM, Paranandi L. Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients. A clinical severity score. JAMA 1992 6;267:2344-8.
3) Chertow GM, Lazarus JM, Christiansen CL, Cook EF, Hammermeister KE, Grover F, et al. Preoperative renal risk stratification. Circulation 1997;95:878-84.
4) Zanardo G, Michielon P, Paccagnella A, Rosi P, Caló M, Salandin V, et al. Acute renal failure in the patient undergoing cardiac operation. Prevalence, mortality rate, and main risk factors. J Thorac Cardiovasc Surg 1994;107:1489-95.
5) Sirivella S, Gielchinsky I, Parsonnet V. Mannitol, furosemide, and dopamine infusion in postoperative renal failure complicating cardiac surgery. Ann Thorac Surg 2000;69:501-6.
6) Rao V, Weisel RD, Buth KJ, Cohen G, Borger MA, Shiono N, et al. Coronary artery bypass grafting in patients with non-dialysis- dependent renal insufficiency. Circulation 1997;96:II-38-43.
7) Butler J, Rocker GM, Westaby S. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 1993;55:552-9.
8) Ascione R, Lloyd CT, Underwood MJ, Gomes WJ, Angelini GD. On-pump versus off-pump coronary revascularization: evaluation of renal function. Ann Thorac Surg 1999;68:493-8.
9) Schwann NM, Horrow JC, Strong MD 3rd, Chamchad D, Guerraty A, Wechsler AS. Does off-pump coronary artery bypass reduce the incidence of clinically evident renal dysfunction after multivessel myocardial revascularization? Anesth Analg 2004;99:959-64.
10) Andersson LG, Ekroth R, Bratteby LE, Hallhagen S, Wesslén O. Acute renal failure after coronary surgery-a study of incidence and risk factors in 2009 consecutive patients. Thorac Cardiovasc Surg 1993;41:237-41.
11) Mangano CM, Diamondstone LS, Ramsay JG, Aggarwal A, Herskowitz A, Mangano DT. Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. The Multicenter Study of Perioperative Ischemia Research Group. Ann Intern Med 1998;128:194-203.
12) Hirose H, Amano A, Yoshida S, Takahashi A, Nagano N, Kohmoto T. Coronary artery bypass grafting in the elderly. Chest 2000;117:1262-70.
13) Lassnigg A, Donner E, Grubhofer G, Presterl E, Druml W, Hiesmayr M. Lack of renoprotective effects of dopamine and furosemide during cardiac surgery. J Am Soc Nephrol 2000;11:97-104.
14) Mahesh B, Yim B, Robson D, Pillai R, Ratnatunga C, Pigott D. Does furosemide prevent renal dysfunction in high-risk cardiac surgical patients? Results of a double-blinded prospective randomised trial. Eur J Cardiothorac Surg 2008;33:370-6.
15) Regragui IA, Izzat MB, Birdi I, Lapsley M, Bryan AJ, Angelini GD. Cardiopulmonary bypass perfusion temperature does not influence perioperative renal function. Ann Thorac Surg 1995;60:160-4.
16) Loef BG, Epema AH, Navis G, Ebels T, van Oeveren W, Henning RH. Off-pump coronary revascularization attenuates transient renal damage compared with on-pump coronary revascularization. Chest 2002;121:1190-4.
17) Ascione R, Nason G, Al-Ruzzeh S, Ko C, Ciulli F, Angelini GD. Coronary revascularization with or without cardiopulmonary bypass in patients with preoperative nondialysis- dependent renal insufficiency. Ann Thorac Surg 2001;72:2020-5.
18) Bucerius J, Gummert JF, Walther T, Schmitt DV, Doll N, Falk V, et al. On-pump versus off-pump coronary artery bypass grafting: impact on postoperative renal failure requiring renal replacement therapy. Ann Thorac Surg 2004;77:1250-6.
19) Chukwuemeka A, Weisel A, Maganti M, Nette AF, Wijeysundera DN, Beattie WS, 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;80:2148-53.
20) Di Mauro M, Gagliardi M, Iacò AL, Contini M, Bivona A, Bosco P, et al. Does off-pump coronary surgery reduce postoperative acute renal failure? The importance of preoperative renal function. Ann Thorac Surg 2007;84:1496-502.