Renal function and cardiopulmonary bypass: Effect of perfusion pressure

Urzúa, Jorge; Troncoso, Sergio; Bugedo, Guillermo; Canessa, Roberto; Muñoz, Hernán R.; Lema, Guillermo; Valdivieso, Andrés; Irarrázaval, Manuel J.; Morán, Sergio; Meneses, Gladys

doi:10.1016/1053-0770(92)90144-v

Cited by 101 publications

(48 citation statements)

References 11 publications

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“…In a study of patients with cardiopulmonary bypass surgery, investigators suggested that mean arterial pressure .70 mmHg was associated with higher intraoperative creatinine clearance when it was compared with the mean arterial pressure of 50-60 mmHg. 7,19 Although TAVR is associated with fewer hemodynamic and inflammatory changes, it could still be associated with increased risk of AKI because of contrast exposure, atheroembolic events, and hemodynamic instability when the valve 10 Interestingly, three separate randomized, controlled studies have shown different rates of postoperative AKI. 10,20,21 Two of the mentioned trials showed no significant difference in postoperative AKI between the TAVR and SAVR groups.…”

Section: Discussionmentioning

confidence: 99%

AKI after Transcatheter or Surgical Aortic Valve Replacement

Thongprayoon

Cheungpasitporn

Srivali

et al. 2015

JASN

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Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for patients with symptomatic severe aortic stenosis who are at high risk of perioperative mortality. Previous studies showed increased risk of postoperative AKI with TAVR, but it is unclear whether differences in patient risk profiles confounded the results. To conduct a propensity-matched study, we identified all adult patients undergoing isolated aortic valve replacement for aortic stenosis at Mayo Clinic Hospital in Rochester, Minnesota from

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Section: Discussionmentioning

confidence: 99%

AKI after Transcatheter or Surgical Aortic Valve Replacement

Thongprayoon

Cheungpasitporn

Srivali

et al. 2015

JASN

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“…The optimal perfusion pressure and flow rates in humans undergoing cardiopulmonary bypass are not known, and both higher perfusion pressure (120) and the use of pulsatile flow (121) have failed to improve postoperative renal function. In animals, renal blood flow seems to be decreased during cardiopulmonary bypass (122,123), although there is a stable period of autoregulation (down to flows as low as 1.6 L/min per minute 2 ) (123).…”

Section: Cardiopulmonary Bypassmentioning

confidence: 99%

AKI Associated with Cardiac Surgery

Thiele¹,

Isbell²,

Rosner

2015

Clinical Journal of the American Society of Nephrology

261

198

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Approximately 18% of patients undergoing cardiac surgery experience AKI (on the basis of modern standardized definitions of AKI), and approximately 2%-6% will require hemodialysis. The development of AKI after cardiac surgery portends poor short-and long-term prognoses, with those developing RIFLE failure or AKI Network stage III having an almost 2-fold increase in the risk of death. AKI is caused by a variety of factors, including nephrotoxins, hypoxia, mechanical trauma, inflammation, cardiopulmonary bypass, and hemodynamic instability, and it may be affected by the clinician's choice of fluids and vasoactive agents as well as the transfusion strategy used. The risk of AKI may be ameliorated by avoidance of nephrotoxins, achievement of adequate glucose control preoperatively, and use of goal-directed therapy hemodynamic strategies. Remote ischemic preconditioning is an exciting future strategy, but more work is needed before widespread implementation. Unfortunately, there are no pharmacologic agents known to reduce the risk of AKI or treat established AKI.

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“…Any deviation in perfusion pressure and flow rates can significantly affect the oxygen delivery to all organs and may result in periods of decreased flow or perfusion pressure, leading to renal injury. (Urzua, Troncoso et al 1992;Fischer, Weissenberger et al 2002) Prolonged cardiopulmonary bypass and aortic cross-clamp times are relatively wellaccepted as being linked to increased postoperative AKI, although this finding has not been present in all studies. (Fischer, Weissenberger et al 2002;Tuttle, Worrall et al 2003) Unfortunately, because of the heterogenous patient populations, no specific time frame has been established after which the risk of AKI increases.…”

Section: Intraoperative Risk Factorsmentioning

confidence: 53%

“…However, neither of these factors has been shown clinically to affect the incidence of postoperative AKI. (Urzua, Troncoso et al 1992;Abramov, Tamariz et al 2003;Provenchère, Plantefève et al 2003) Dilutional anemia during CPB has been associated with increased overall morbidity following cardiac surgery. Specifically, lowest on-pump hematocrit below 22-24% may put patients at risk for postoperative AKI.…”

Section: Intraoperative Risk Factorsmentioning

confidence: 99%