The impact of minimal invasive extracorporeal circulation on postoperative kidney function

Media, Ara Shwan; Juhl-Olsen, Peter; Magnusson, Nils E.; Modrau, Ivy Susanne

doi:10.1177/0267659120954601

Cited by 6 publications

(5 citation statements)

References 24 publications

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“…These findings are limited by the small sample size and use of the AKIN classification, but assume greater importance given the lack of randomised trial data for patients concerning renal outcomes. 86 Similar findings have been reported in other small RCTs. 87 However, potential findings of reduced inflammatory and procoagulant mediators is likely to further fuel investigation of MiECC.…”

Section: Proposed Perfusion-based Approaches To Reduce Acute Kidney I...supporting

confidence: 84%

Adverse renal effects associated with cardiopulmonary bypass

et al. 2023

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Cardiac surgery on cardiopulmonary bypass (CPB) is associated with postoperative renal dysfunction, one of the most common complications of this surgical cohort. Acute kidney injury (AKI) is associated with increased short-term morbidity and mortality and has been the focus of much research. There is increasing recognition of the role of AKI as the key pathophysiological state leading to the disease entities acute and chronic kidney disease (AKD and CKD). In this narrative review, we will consider the epidemiology of renal dysfunction after cardiac surgery on CPB and the clinical manifestations across the spectrum of disease. We will discuss the transition between different states of injury and dysfunction, and, importantly, the relevance to clinicians. The specific facets of kidney injury on extracorporeal circulation will be described and the current evidence evaluated for the use of perfusion-based techniques to reduce the incidence and mitigate the complications of renal dysfunction after cardiac surgery.

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Section: Proposed Perfusion-based Approaches To Reduce Acute Kidney I...supporting

confidence: 84%

Adverse renal effects associated with cardiopulmonary bypass

et al. 2023

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“…There was no significant difference in any of the clinical outcomes related to inflammation and SIRS. Other clinical outcomes regarding coagulation and renal function have been published previously [ 14 , 15 ].…”

Section: Resultsmentioning

confidence: 99%

“…Anaesthetic regimen, operative treatment and postoperative management were comparable as previously described in detail [ 14 , 15 ]. All procedures were performed by members of the MiECC team at our institution including two surgeons to minimize interpersonal variability.…”

Section: Methodsmentioning

confidence: 99%

“…We continued measurements of CRP and WBC up to the fourth postoperative day. All blood samples were analysed as previously described [ 14 , 15 ]. For cytokine analysis (TNF-alpha, IL1-beta, IL-6, IL-8), blood was drawn from an arterial cannula into 3,2% sodium citrate tubes and centrifuged at 3,000 g for 25 minutes at 20°C within 1 hour after blood sampling.…”

Section: Methodsmentioning

confidence: 99%

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Impact of minimal invasive extracorporeal circulation on systemic inflammatory response – a randomized trial

Halle,

Benhassen,

Søberg

et al. 2024

J Cardiothorac Surg

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Background Extracorporeal circulation causes a systemic inflammatory response, that may cause postoperative haemodynamic instability and end-organ dysfunction. This study aimed to investigate the impact of minimal invasive extracorporeal circulation (MiECC) on the systemic inflammatory response compared with conventional extracorporeal circulation (CECC). Methods Patients undergoing coronary artery bypass grafting were randomized to MiECC (n = 30) and CECC (n = 30). Primary endpoint was tumor necrosis factor-α. Secondary endpoints were other biochemical markers of inflammation (IL1β, IL6 and IL8, C-reactive protein, leukocytes), and markers of inadequate tissue perfusion and tissue damage (lactate dehydrogenase, lactate and creatine kinase-MB). In addition, we registered signs of systemic inflammatory response syndrome, haemodynamic instability, atrial fibrillation, respiratory dysfunction, and infection. Results Patients treated with MiECC showed significantly lower levels of tumor necrosis factor-α than CECC during and early after extracorporeal circulation (median: MiECC 3.4 pg/mL; CI 2.2–4.5 vs. CECC 4.6 pg/mL; CI 3.4–5.6; p = 0.01). Lower levels of creatine kinase-MB and lactate dehydrogenase suggested less tissue damage. However, we detected no other significant differences in any other markers of inflammation, tissue damage or in any of the clinical outcomes. Conclusions Lower levels of TNF-α after MiECC compared with CECC may reflect reduced inflammatory response, although other biochemical markers of inflammation were comparable. Our results suggest better end-organ protection with MiECC compared with CECC. Clinical parameters related to systemic inflammatory response were comparable in this study. Clinical registration number NCT03216720.

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“…Owing to the attenuated hemodilution from reduced priming solution, the removal volume of water-soluble components in ultrafiltration was reduced. Additionally, red blood cells and blood colloidal osmotic pressure remained at a relatively high level, the latter leading to a higher perfusion pressure in the kidney [17]. Therefore, patients in the modified group displayed a lower ultrafiltration solution volume and a higher intraoperative urine volume.…”

Section: Discussionmentioning

confidence: 99%

Modified cardiopulmonary bypass with low priming volume for blood conservation in cardiac valve replacement surgery

Yang

Huang

Dai

et al. 2023

J Cardiothorac Surg

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Background The adverse effects of cardiopulmonary bypass during open cardiac surgery, including hemodilution, seem to be inevitable, especially for patients who generally have a relatively lower BMI with relatively small blood volumes. This study reports the modification and use of a cardiopulmonary bypass (CPB) system to reduce priming volume and hemodilution. Methods This is a retrospective study of 462 adult patients who underwent cardiac valve replacement surgery from January 2019 to September 2021 at the General Hospital of Western Theater Command. The modified group consisted of 212 patients undergoing modified CPB. The control group included 250 patients receiving conventional CPB. Evaluated indices included fluid intake and output volumes during CPB, intraoperative indices related to CPB operation, usage of blood products during the peri-CPB period, and postoperative outcomes. Results The modified group displayed a significant reduction in the crystalloid (200 mL vs. 600 mL, P < 0.05) and colloid priming volumes (450 mL vs. 1100 mL, P < 0.05), and ultrafiltration solution volume (750 mL vs. 1200 mL, P < 0.05). Furthermore, the modified group had a significantly lower rate of defibrillation (30.2% vs. 41.2%, P < 0.05). The intraoperative urine volume (650 mL vs. 500 mL, P < 0.05) and intraoperative hematocrit (Hct) (26% vs. 24%, P < 0.05) of the modified CPB group were also higher than in the control group. The modified group required a lower infusion volume of packed red blood cells (250 mL vs. 400 mL, P < 0.05) and lower infusion rates of packed red blood cells (17.9% vs. 25.2%, P < 0.05) and fresh frozen plasma (1.41% vs. 5.2%, P < 0.05). In addition, the modified group showed significantly improved indices related to postoperative recovery. Conclusions The modified CPB system effectively conserves blood and shows noteworthy potential for application in cardiac valve replacement surgery.

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The impact of minimal invasive extracorporeal circulation on postoperative kidney function

Cited by 6 publications

References 24 publications

Adverse renal effects associated with cardiopulmonary bypass

Adverse renal effects associated with cardiopulmonary bypass

Impact of minimal invasive extracorporeal circulation on systemic inflammatory response – a randomized trial

Modified cardiopulmonary bypass with low priming volume for blood conservation in cardiac valve replacement surgery

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