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Renal Outcomes and Myocardial Performance after On-Pump Beating Heart versus Conventional On-Pump Surgery in Patients with Preoperative Low Glomerular Filtration Rate

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World Journal of Cardiovascular Diseases 2016年第11期6卷 433-445页

作者： salih colak Davut Azboy Zeki Temizturk Hakan Atalay Omer Faruk Dogan Dilek Dogan Emjed Khalil Kenan Abdurrahman Kara Department of Cardiology The Health and Science University Adana Numune Education and Training Hospital Adana Turkey Department of Cardiovascular Surgery The Health and Science University Elazig Education and Training Hospital Elazig Turkey Department of Cardiovascular Surgery Mersin Private Middle-East Hospital Mersin Turkey Department of Cardiovascular Surgery The Health and Science University Adana Numune Education and Training Hospital Adana Turkey Department of Dietetic and Parenteral Nutrition The Health and Science University Adana Numune Education and Training Hospital Adana Turkey Department of Cardiovascular Surgery The Private Medicana ?aml?ca Hospital Istanbul Turkey

Objective: Acute kidney disease develops 16% - 30% of patients with preoperative impaired renal functions. Our aim of this study was to compare postoperative renal outcomes using two open heart surgery techniques, on-pump beating heart (OPBH) and conventional on-pump (COP), in patients who have preoperative low glomerular filtration rate (eGFR) as an indicator of creatinine clearance. Methods: From 2004 to 2015, 341 patients with preoperative creatinine clearance were lower than 90 ml/min/1.73m2 were selected for this study. On-Pump beating heart was performed in 111 patients (Group I). Conventional on-pump technique was used in 200 patients. In the remaining patients, we measured postoperative Tumor Necrosis Factor Alpha (TNF-alpha), cardiac troponin I (cTn-I), Brain natriuretic peptid (NT-Pro- BNP), creati-nine (Cr), blood urea nitrogen (BUN) and postoperative eGFR daily until day four after surgery. Results: There were no differences in baseline levels of TNF-alpha, NT-Pro-BNP, BUN, cTn-I, Cr levels between the groups. Cardiopulmonary bypass (CPB) time were much longer and cumulative inotrope use was significantly higher in patients underwent COP (P Conclusion: Our study showed that on-pump beating heart CABG technique provides a morbidity benefit and is associated with a lower risk of peroperative LOS in patients with mild renal disfunction. Our study results suggest that OPBH is superior to the COP in terms of postoperative renal injury and cardiac mediators.

关键词： Open Heart Surgery Beating Heart Postoperative Renal Failure

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