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

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.

Anahtar Kelimeler

• coronary bypass
• renal function
• acute kidney injury

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

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.

Anahtar Kelimeler

• koroner bypass
• renal fonksiyon
• akut böbrek yetmezliği

Kaynakça

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