Renal complications associated with valve replacement surgery

Porter, George A.; Kloster, Frank E.; Herr, Rodney J.; Starr, Albert; Griswold, Herbert E.; Kimsey, Jean

doi:10.1016/s0022-5223(19)43250-9

Cited by 46 publications

(8 citation statements)

References 11 publications

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“…Los pacientes valvulares son considerados un grupo de alto riesgo de daño renal. La mayor parte de los estudios realizados en este grupo de pacientes, es antigua, realizados con técnicas quirúrgicas y de CEC muy disímiles a la tecnología actual [7][8][9] .…”

Section: N V E S T I G a C I ó Nunclassified

Función renal en cirugía cardíaca con circulación extracorpórea: Pacientes valvulares y coronarios

et al. 2008

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Renal function during cardiac surgery with extracorporeal circulationBackground: Patients with valvular heart disease are at high risk of acute renal failure after surgery with extracorporeal circulation. Aim: To describe changes in renal function parameters during surgery with extracorporeal circulation in patients with valvular heart disease and compare them with those found in patients undergoing elective coronary surgery. Material and Methods: Two groups of patients were studied. Group 1 was composed by twelve patients undergoing elective coronary surgery and group 2 was composed by eleven patients undergoing surgery for heart valve replacement. Glomerular filtration rate and effective renal plasma flow were estimated from inulin and the 131 I-hippuran clearance respectively, at five different times, during surgery and the postoperative period. Sodium filtration fraction and fractional excretion were calculated. Alpha and pi-glutathione stransferase in urine were measured as markers of tubular damage in the pre and postoperative periods. Results: Effective renal plasma flow was reduced in both groups before induction of anesthesia, did not change during surgery and decreased significantly in patients with valvular disease in the postoperative period. Glomerular filtration rates were normal during all the study period. There was a non significant reduction of filtration fraction during extracorporeal circulation. Alpha and pi glutathione s-transferases were normal and did not change. Fractional excretion of sodium increased significantly postoperatively. Conclusions: In patients with valvular disease undergoing surgery with extracorporeal circulation, renal function does not deteriorate. No significant difference was found when compared with patients undergoing coronary surgery. No evidence of functional and cellular renal disfunction or damage was found in both study groups (

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Section: N V E S T I G a C I ó Nunclassified

Función renal en cirugía cardíaca con circulación extracorpórea: Pacientes valvulares y coronarios

et al. 2008

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“…• Covariates can predict about 10% of the variability in creatinine rise relative to baseline after CABG surgery, providing clues about the pathophysiology of renal dysfunction. 1,3,4,7,[21][22][23][24][25][26][27][28][29][30][31][32][33][34] • Preoperative predictive factors include advanced age, 3,4,22,31,33,34 African-American race, 3,35 increased body weight, 3 hypertension, 21,36 carotid or peripheral atherosclerotic vascular disease, 3,21 diabetes mellitus and elevated preoperative serum glucose, 3,4,36,37 reduced left ventricular function, and obstructive pulmonary disease. 3,21,22,27,28 The role of preexisting renal disease as a risk factor for acute renal injury is complex.…”

Section: Clinical Decision-makingmentioning

confidence: 99%

Evidence-Based Renal Protection in Cardiac Surgery

Stafford‐Smith

2005

Semin Cardiothorac Vasc Anesth

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Acute renal dysfunction is a common serious complication of cardiac surgery. Although a diversity of mechanisms exist by which the kidney can be damaged during cardiac surgery, atheroembolism, ischemia-reperfusion, and inflammation are believed to be primary contributors to perioperative renal insult. In addition, the high metabolic demands of active tubular reabsorption and the oxygen diffusion shunt characteristic of renal circulation make the kidney particularly vulnerable to ischemic injury. Remote effects of acute renal injury likely contribute to the strong association of this condition with other major postoperative morbidities and mortality and justify the search for renoprotective agents, even when dialysis is never required. Nonpharmacologic preventive strategies include procedure planning that is based on risk stratification, avoidance of nephrotoxins, and meticulous perioperative clinical care, including optimizing intravascular volume and attention to modifiable risk factors such as minimizing hemodilution. Although numerous pharmacologic interventions to prevent or treat acute renal injury have shown promise in animal models, randomized placebo-controlled clinical trials that have looked at measures of significant adverse outcomes such as death and dialysis have not confirmed a benefit.

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“…Altogether, the occurrence of pathologic CH 2 O values proved to be the earliest, most frequent and most reliable criterion for the recognition of ARF following cardiac surgery with cardiac-pulmonary bypass. Key-Words: Acute renal failure -Cardiac surgery -Cardiopulmonary bypass -Free water clearance Table 1 Acute renal failure (ARF) following cardiac surgery Acute renal failure (ARF) following cardiac surgery, although a rare event, has a high mortality rate (Table 1) (4,6,7,9,12,13,17,18,20). In order to reduce its frequency it is necessary to establish the diagnosis as early as possible.…”

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confidence: 99%

The Diagnosis of Acute Renal Failure (ARF) Following Cardiac Surgery with Cardio-Pulmonary Bypass

Holper¹,

Struck²,

Sebening³

1979

Thorac cardiovasc Surg

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The diagnostic value of renal concentrating capacity expressed as free water clearance (CH2O), in comparison with other routine criteria for the early identification of acute renal failure (ARF), was evaluated in 1,203 adult patients undergoing cardiac surgical procedures. On the basis of the appearance of pathologic CH2O values in the range of -20 to 0 ml/hour or more positive, reversible or irreversible ARF was observed in 90 (= 7.5%) of our patients. Mortality in the presence of ARF was 47%; total ARF mortality was 3.5%. CH2O was pathologic for the first time on an average of 1.6 days after operation. In contrast, routine ARF criteria reported in the literature, such as serum urea and creatinine at varying substrate levels or oliguria, allowed diagnosis 1 to 5.5 days later. Moreover, these parameters only partially and less frequently met the criteria for ARF at the different levels. Likewise, the incidence of ARF decreased to a minimum of 1.7% and the total ARF mortality to 1.3%, depending on the severity of the criteria used. Altogether, the occurrence of pathologic CH2O values proved to be the earliest, most frequent and most reliable criterion for the recognition of ARF following cardiac surgery with cardiac-pulmonary bypass.

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Renal complications associated with valve replacement surgery

Cited by 46 publications

References 11 publications

Función renal en cirugía cardíaca con circulación extracorpórea: Pacientes valvulares y coronarios

Función renal en cirugía cardíaca con circulación extracorpórea: Pacientes valvulares y coronarios

Evidence-Based Renal Protection in Cardiac Surgery

The Diagnosis of Acute Renal Failure (ARF) Following Cardiac Surgery with Cardio-Pulmonary Bypass

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