Miniaturized extracorporeal circulation vs. off-pump coronary artery bypass grafting: What the evidence shows?

Harling, Leanne; Punjabi, Prakash P; Athanasiou, Thanos

doi:10.1177/0267659110396578

Cited by 14 publications

(14 citation statements)

References 41 publications

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“…An important factor is the bio-incompatibility of blood in contact with the artificial surface of the CPB circuit [54]. Modifications that are available to improve biocompatibility include the phosphorylcholine-coated circuit and the Carmeda-coated circuit.…”

Section: Optimizing Cardiac Surgical Procedures and Cpb Parametersmentioning

confidence: 99%

Cardiac Surgery-Associated Acute Kidney Injury

et al. 2014

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Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common and serious postoperative complication of cardiac surgery requiring cardiopulmonary bypass (CPB), and it is the second most common cause of AKI in the intensive care unit. Although the complication has been associated with the use of CPB, the etiology is likely multifactorial and related to intraoperative and early postoperative management including pharmacologic therapy. To date, very little evidence from randomized trials supporting specific interventions to protect from or prevent AKI in broad cardiac surgery populations has been found. The definition of AKI employed by investigators influences not only the incidence of CSA-AKI, but also the identification of risk variables. The advent of novel biomarkers of kidney injury has the potential to facilitate the subclinical diagnosis of CSA-AKI, the assessment of its severity and prognosis, and the early institution of interventions to prevent or reduce kidney damage. Further studies are needed to determine how to optimize cardiac surgical procedures, CPB parameters, and intraoperative and early postoperative blood pressure and renal blood flow to reduce the risk of CSA-AKI. No pharmacologic strategy has demonstrated clear efficacy in the prevention of CSA-AKI; however, some agents, such as the natriuretic peptide nesiritide and the dopamine agonist fenoldopam, have shown promising results in renoprotection. It remains unclear whether CSA-AKI patients can benefit from the early institution of such pharmacologic agents or the early initiation of renal replacement therapy.

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Section: Optimizing Cardiac Surgical Procedures and Cpb Parametersmentioning

confidence: 99%

Cardiac Surgery-Associated Acute Kidney Injury

et al. 2014

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“…In on-pump cardiac surgery, various factors effect renal perfusion and stimulate renal vasoconstriction: systemic inflammation, hypoperfusion, ischemia reperfusion injury, acidosis, vasopressor medications, hypothermia, hemolysis, embolism and nonpulsatile flow [21,22,23,24]. The release of vasodilator cyclooxygenase metabolites and the formation of nitric oxide following compromised renal circulation are important for the restoration of renal blood flow after ischemia reperfusion injury of the renal vascular bed [25].…”

Section: Discussionmentioning

confidence: 99%

Clinical SYNTAX Score Can Predict Acute Kidney Injury following On-Pump but Not Off-Pump Coronary Artery Bypass Surgery

et al. 2015

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Background: The complexity of coronary artery disease is usually a neglected factor in risk stratification systems. We aimed to analyze the discriminative ability of the clinical SYNTAX score (CSS) for acute kidney injury (AKI) following on- and off-pump coronary artery surgery. Methods: A total of 193 patients were reviewed in this study. Patients were divided into two groups according to the surgical procedure (group I: off-pump coronary artery bypass grafting, n = 89; group II: on-pump coronary artery bypass grafting, n = 104). Preoperative demographic data, the CSS and postoperative renal functions were evaluated. The postoperative AKI classification was made using the RIFLE (Risk, Injury, Failure, Loss of function, and End-stage renal disease) criteria. Results: Postoperative AKI occurred in 14 of 89 patients (15.7%) in group I and in 29 of 104 patients in group II (27.8%; p = 0.046). The CSS did not vary much between the groups (31.52 ± 13.08 vs. 29.89 ± 15.70; p = 0.638). In group I, the CSS was not different between patients with AKI and those without AKI (30.167 ± 3.93 vs. 31.91± 14.75; p = 0.78). In group II, the CSS was 36.85 ± 18.33 in patients with AKI and 28.02 ± 12.32 in those without, and the difference was significant (p = 0.02). The discriminative ability of the CSS for postoperative AKI using the AUC analysis was 0.500 in group I and 0.840 in group II. Conclusion: The CSSmay be a simple and successful means of risk prediction of postoperative AKI in on-pump coronary artery surgery.

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“…Harling [5] outlines a number of common features that these M-CPB circuits utilize which will be discussed. First, a heparin/ phosphorylcholine/polymer coated tubing to reduce protein adsorption and platelet activation.…”

Section: Common Features To M-cpbmentioning

confidence: 99%

Advantages to Miniaturized Cardiopulmonary Bypass for Adult Cardiac Surgery

Chatterjee

2013

J Clin Exp Cardiolog

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Miniaturized extracorporeal circulation vs. off-pump coronary artery bypass grafting: What the evidence shows?

Cited by 14 publications

References 41 publications

Cardiac Surgery-Associated Acute Kidney Injury

Cardiac Surgery-Associated Acute Kidney Injury

Clinical SYNTAX Score Can Predict Acute Kidney Injury following On-Pump but Not Off-Pump Coronary Artery Bypass Surgery

Advantages to Miniaturized Cardiopulmonary Bypass for Adult Cardiac Surgery

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