In our study, we found that Dexmedetomidine infusion for sedation after CABG under cardiopulmonary bypass can be useful in the prevention of kidney injury. Conventional renal function tests, including blood urea nitrogen, serum creatinine, urine output and creatinine clearance rate measurements typically may not detect the development of acute kidney dysfunction in the first 48-h postoperative period. Differences were detected in renal function in the early postoperative period and the development of acute kidney injury, as determined by measurements of blood NGAL levels, was significant and dose-dependent.

PAD, DM, and sheathed insertion technique are the major risk factors of ischemia during IABP use. Among all these risk factors, the only modifiable risk factor is the use of introducer sheath. With the presence of PAD and DM, the choice of sheathed method would increase the probability of ischemia almost 35 times. Sheathless method of insertion should be preferred in patients with DM and PAD.

Subaortic stenosis (SAS) is a wide spectrum of anatomical derangements ranging from a discrete fibrous membrane to tortuous fibrous tunnel with or without aortic annulus hypoplasia. We have reviewed 88 patients undergoing surgery for SAS over a 15-year period. There were 47 male and 41 female patients with a mean age of 19.8 +/- 10.6 years (range 11 to 39). Fifty-eight patients had discrete subaortic membrane, and 30 patients had diffuse tunnel subvalvular stenosis. The mean systolic pressure gradients were found to be 86.5 +/- 31.4 mmHg (range 48 to 145 mmHg). Ten patients had mild and 13 patients had moderate-to-severe aortic insufficiency (AI) preoperatively. Nine patients had bicuspid aortic valve. Forty patients (45.4%) had associated cardiac lesions. Isolated membranectomy was performed in six patients. Membranectomy associated with septal myectomy was done in 52 patients. Fifteen patients of them associated hypoplasia of the aortic orifice necessitated aortic valve replacement (AVR) using the Konno-Rastan procedure. Fifteen patients with tunnel SAS and normal aortic valves underwent a combined approach for valve sparing, a modified Konno procedure with patch septoplasty. Also eight patients required AVR because of the severity of AI and five patients aortic reconstruction procedures. Aortic commissurotomy was performed to relief of stenosis in four patients. There were three early deaths (3.4%) and one late death (1.1%) all after the Konno-Rastan procedure. Eight patients (9.1%) had permanent conduction abnormalities. Postoperative left ventricle-aorta gradient was significantly decreased at early postoperative period (p < 0.001) and ranged from 10 to 25 mmHg (mean 14.1 +/- 4.3). Fourteen patients (16.5%) were reoperated for recurrent obstruction or progression of AI. The mean reoperation interval was 4.4 +/- 1.7 years (range 2 to 8 years). Five-year reoperation-free survival was 88.0 +/- 3.6% and 12.5-year reoperation-free survival was 75.5 +/- 7.0%. Our results of aggressive surgical approach of subvalvular aortic stenosis produces relief of obstruction and frees the valve leaflets, significantly reducing associated AI with long-term survival and long-term adequate relief of left ventricular outflow tract obstruction.

Bu çalışmada deksmedetomidinin koroner arter baypas greft (KABG) cerrahisini takiben renal fonksiyonlar üzerindeki muhtemel etkileri araştırıldı. Ça lış ma pla nı: 2008 Ağustos-2009 Mayıs tarihleri arasında kliniğimizde KABG cerrahisi uygulanan ardışık 100 hasta bu çift kör ve plasebo kontrollü çalışmaya dahil edildi. Hastalar deksmedetomidin infüzyonu veya plaseboya randomize edildi. Hastaların sedasyon düzeyi, Ramsey Sedasyon Skalası kullanılarak düzenlendi. Dörtlü permütasyon blokları yöntemi kullanılarak, hastalar randomize edildi. Bul gu lar: Deksmedetomidin grubunda 49, plasebo grubunda 37 hasta olmak üzere, toplam 86 hasta analize tabi tutuldu. Gruplar arasında majör ameliyat sırası ve sonrası değişkenler açısından istatistiksel olarak anlamlı bir farklılık yoktu. Gruplar arasında ameliyat sonrası 1. gün kreatinin klirensi düzeyleri açısından, 110 µg/gün kesim değeri üzerinde anlamlı farklılık olduğu saptandı. Bu değişikliklerin ameliyat sonrası 5. gün kreatinin klirensi düzeylerinde olmadığı belirlendi. So nuç:Düşük doz deksmedetomidinin idrar çıkışı ve kan üre, kreatinin ve kreatinin klirensi gibi renal fonksiyon göstergeleri üzerinde belirgin etkisi yoktur. Ancak toplam dozdaki artışa bağlı olarak, renal fonksiyonlar üzerinde pozitif bir etkisi olabilir. Anah tar söz cük ler: Koroner arter baypas greft cerrahisi; deksmedetomidin; renal fonksiyon. Background: This study aims to investigate possible effects of dexmedetomidine on renal functions following coronary artery bypass graft (CABG) surgery. Methods: Between August 2008 and May 2009, consecutive 100 patients who underwent CABG surgery in our clinic were included in this double-blind and placebo-controlled study. Patients were randomized to either dexmedetomidine infusion or placebo. The sedation level of the patients was regulated using Ramsey Sedation Scale. Permuted blocks of four method was used to randomize patients. Results: A total of 86 patients were included in the analysis including 49 in the dexmedetomidine group and 37 in the placebo group. There was no statistically significant difference in major intraoperative and postoperative variables between the groups. Postoperative day 1 creatinine clearances values above cutoff point of 110 µg/day were significantly different between the groups. These changes were not observed in postoperative fifth day creatinine clearances values. Conclusion: Low dose dexmedetomidine has no major effect on urine output and renal indices such as urea, creatinine and creatinine clearances. However, it may have a positive effect on renal functions when total dose is uptitrated, particularly.

Constant negative suction at -80 mmHg during elective coronary bypass operations caused more hemolysis. We do not recommend a constant suction of -80 mmHg for VAVD.