Thorac Cardiovasc Surg 2005; 53(1): 46-51
DOI: 10.1055/s-2004-830457
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Clinical Outcome for On-Pump Myocardial Revascularization in Patients with Mild Renal Dysfunction

M. Monaco1 , L. Di Tommaso1 , M. Mottola1 , P. Stassano1 , G. Iannelli1
  • 1Department of Cardiac Surgery, University “Federico II”, Naples, Italy
Further Information

Publication History

Received August 11, 2004

Publication Date:
03 February 2005 (online)

Abstract

Background: Coronary artery disease is the major cause of death in patients with chronic renal failure. We studied the early and long-term outcome of patients with mild chronic renal impairment, preoperative regular diuresis, and normal potassium levels having undergone pump myocardial revascularization. Methods: From January 1992 to December 2000, 67 patients with serum creatinine level higher than 1.7 mg/dl and less than 2.5 mg/dl underwent on-pump myocardial revascularization. The patients were divided into 2 groups and treated with renal doses of dopamine in the postoperative or preoperative period, respectively. A homogeneous group of 100 patients was selected as control. Results: There were no statistically significant differences in mortality and morbidity between the two groups A, while there was a significant difference in cardiac and respiratory complications, ICU stay and LOS between the A and B group in the early and long-term follow-up. Survival at 12-year follow-up is significantly higher in the B group. Conclusions: Patients with relatively mild renal insufficiency should be evaluated carefully for open cardiac surgery due to the significant increase in early and long-term morbidity and mortality.

References

  • 1 Hirose H, Amano A, Takahashi A, Nagano N. Coronary artery bypass grafting for patients with non-dialysis-dependent renal dysfunction (serum creatinine ≥ 2. 0 mg/dl).  Eur J Cardiothorac Surg. 2001;  20 565-572
  • 2 Rao V, Weisel R D, Buth K J. et al . Coronary artery bypass grafting in patients with non-dialysis dependent renal insufficiency.  Circulation. 1997;  96 38-43
  • 3 Durmaz I, Büket S, Atay Y. et al . Cardiac surgery with cardiopulmonary bypass in patients with chronic renal failure.  J Thorac Cardiovasc Surg. 1999;  118 306-315
  • 4 Sirivella S, Gielchinsky I, Parsonnet V. Mannitol, furosemide, and dopamine infusion in postoperative renal failure complicating cardiac surgery.  Ann Thorac Surg. 2000;  69 501-506
  • 5 Cherlow G M, Levy E M, Hammermeister K E. et al . Independent association between acute renal failure and mortality following cardiac surgery.  Am J Med. 1998;  104 343-348
  • 6 US Renal Data System .USRDS 1991 Annual Data Report. Bethesda, MD; Natl Inst Diabetes Dig Kidney Dis 1991: 31-40
  • 7 Corwin H L, Sprague S M, DeLaria G A, Norusis M J. Acute renal failure associated with cardiac operations.  J Thorac Cardiovasc Surg. 1989;  98 1107-1112
  • 8 Butler J, Rocker G M, Westaby S. Inflammatory response to cardiopulmonary bypass.  Ann Thorac Surg. 1993;  55 552-559
  • 9 Hickey P R, Buckley M J, Philbin D M. Pulsatile and nonpulsatile cardiopulmonary bypass: review of a counterproductive controversy.  Ann Thorac Surg. 1983;  36 720-737
  • 10 Regragui I A, Izzat M B, Birdi I. et al . Cardiopulmonary bypass perfusion temperature does not influence perioperative renal function.  Ann Thorac Surg. 1995;  60 160-164
  • 11 Boldt J, Brenner T, Lehmann A. et al . Is kidney function altered by the duration of cardiopulmonary bypass?.  Ann Thorac Surg. 2003;  75 906-912
  • 12 Warnock D G. Diuretics. Katzung BG Basic Clinical Pharmacology. 3rd ed. Norwalk, CT; Appleton and Lange 1987: 169-182
  • 13 Ebadi M. Diuretics. Ebadi M Pharmacology. 2nd ed. Boston; Little Brown 1993: 227-239
  • 14 Olsen N V. Effects of dopamine on renal hemodynamics tubular function and sodium excretion in normal humans.  Dan Med Bull. 1998;  45 282-297
  • 15 Davis R, Lappas D, Kirklin J. et al . Acute oliguria after cardio-pulmonary bypass: renal functional improvement with low-dose dopamine infusion.  Crit Care Med. 1982;  10 852-856
  • 16 Tang A TM, El Gamel A, Keevil B. et al . The effect of “renal-dose” dopamine on renal tubular function following cardiac surgery assessed by measuring retinol binding protein (RBP).  Eur J Cadiothorac Surg. 1999;  15 717-722
  • 17 Woo E BC, Tang A TM, El Gamel A. et al . Dopamine therapy for patients at risk of renal dysfunction following cardiac surgery: science or fiction?.  Eur J Cardiothorac Surg. 2002;  22 106-111
  • 18 Van Belleghem Y, Caes F, Maene L. et al . Off-pump coronary surgery: surgical strategy for high-risk patient.  Cardiovasc Surg. 2003;  11 75-79
  • 19 Bucerius J, Gummert F J, Walther T. et al . On-pump versus off-pump coronary artery bypass grafting: impact on postoperative renal failure requiring renal replacement therapy.  Ann Thorac Surg. 2004;  77 1250-1256
  • 20 Sakagoshi N, Yasuda H, Tayama M. The analysis of renal function in off-pump coronary artery bypass grafting.  Kyobu Geka. 2003;  56 857-860

Dr. M. Monaco

Department of Cardiac Surgery, University “Federico II”

Via A. Falcone 258

80127 Naples

Italy

Phone: + 390815784955

Fax: + 39 08 17 46 25 01

Email: mariomonaco55@libero.it

    >