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Sodium/hydrogen-exchanger inhibition decreases myocardial edema immediately after cardiopulmonary bypass and cardioplegic arrest and improves preload recruitable stroke work. Sodium/hydrogen-exchange inhibition during cardiac procedures with cardiopulmonary bypass and cardioplegic arrest may be a useful adjunct to improve myocardial performance in the immediate postbypass or arrest period.

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O Ob bj je ec ct ti iv ve es s: : Acute renal failure (ARF) is a common complication following open heart surgery especially in infants. Effects of blood viscosity on renal function are well known, but have not been investigated in cardiopulmonary bypass (CPS) as yet. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : We investigated blood viscosity and different markers of glomerular and tubular renal function in a group of 37 infants below 18 month of age, receiving CPS surgery for different diagnoses. In an experimental setting, we investigated 28 isolated pig-kidneys with different hematocrits in an autologous blood perfused model. R Re es su ul lt ts s: : In infants, creatinine clearance decreased and urinary excretion of albumin and β-NAG increased during the aortic cross clamp time (AT) and during the first hours following operation, indicating moderate glomerular and tubular damage. During AT, blood was hemodiluted to a hemoglobin of 8.4 ± 0.4 g/dl. Thus, blood viscosity during AT and hypothermia was slightly below pre-CPB values. Lower blood viscosity was related to less renal damage (P < 0.01). In isolated pig-kidneys, group I (n = 14) was perfused with a hemoglobin of 10.2 ± 0.3 g/dl and group II (n = 14) was hemodiluted to 6.5 ± 0.9 g/dl. Group II kidneys showed lower vascular resistance, elevated creatinine clearance, elevated oxygen consumption and elevated sodium reabsorption (P < 0.05). C Co on nc cl lu us si io on ns s: : Reducing blood viscosity below physiological values improves tubular as well as glomerular function under CPB conditions. Thus we hold hemodilution to be an appropriate method for optimizing CPB procedures.