Cardiopulmonary bypass and renal injury

Abu-Omar, Yasir; Ratnatunga, Chandana
July 2006
Perfusion;Jul2006, Vol. 21 Issue 4, p209
Academic Journal
Renal dysfunction following cardiopulmonary bypass (CPB) is well recognized. The extent of perioperative renal impairment ranges from subclinical injury to established renal failure requiring dialysis. Its incidence varies considerably, depending on the definition and criteria used in the different studies. Acute renal failure (ARF) affects 1–5% of patients and remains a major cause of morbidity and mortality. Co-morbidities, including diabetes mellitus, impaired left ventricular function and advanced age, are recognized predisposing factors. The pathophysiology is multifactorial and is thought related to the systemic inflammatory response and renal hypoperfusion secondary to extracorporeal circulation. Non-pulsatile flow during CPB is thought to be an important aetiological factor, resulting in renal vasoconstriction and ischaemic renal injury. A theoretical reduction in the incidence and severity of postoperative renal impairment has been proposed by advocating the use of pulsatile flow during CPB, or eliminating CPB, especially in high-risk patients. The current evidence, however, is conflicting. Several large observational studies, including a large proportion of high-risk patients, have demonstrated a significant reduction in the frequency of renal failure in patients undergoing off-pump surgery. As older, sicker patients increasingly constitute the cardiac surgical population, the incidence of postoperative renal injury is likely to increase. Further studies addressing various renoprotective strategies in higher-risk patients are awaited.


Related Articles

  • Cardiopulmonary bypass management and acute renal failure: risk factors and prognosis. Sirvinskas, E.; Andrejaitiene, J.; Raliene, L.; Nasvytis, L.; Karbonskiene, A.; Pilvinis, V.; Sakalauskas, J. // Perfusion;Nov2008, Vol. 23 Issue 6, p323 

    The aim of the study was to investigate if acute renal failure (ARF) following cardiac surgery is influenced by CPB perfusion pressure and to determine risk factors of ARF. Our research consisted of two studies. In the first study, 179 adult patients with normal preoperative renal function who...

  • HEART SURGERY IN PATIENTS ON CHRONIC DIALYSIS. STOJANOVIĆ, Dragana UNIĆ; MILIČIĆ, Miroslav; VUKOVIĆ, Petar; BABIĆ, Srđan; JOVIĆ, Miomir // Medicinski Pregled / Medical Review;Jan2013, Vol. 66 Issue 1, p64 

    Introduction. Patients on dialysis for end-stage renal failure are subjected to cardiac surgery with increasing frequency. End-stage renal failure is known to be an important risk factor for complications of cardiac operations performed with cardiopulmonary bypass. The aim of this study was to...

  • Angiopoietin/Tie2 Dysbalance Is Associated with Acute Kidney Injury after Cardiac Surgery Assisted by Cardiopulmonary Bypass. Jongman, Rianne M.; van Klarenbosch, Jan; Molema, Grietje; Zijlstra, Jan G.; de Vries, Adrianus J.; van Meurs, Matijs // PLoS ONE;8/26/2015, Vol. 10 Issue 8, p1 

    Introduction: The pathophysiology of acute kidney injury (AKI) after cardiac surgery is not completely understood. Recent evidence suggests a pivotal role for the endothelium in AKI. In experimental models of AKI, the endothelial specific receptor Tie2 with its ligands Angiopoietin (Ang) 1 and...

  • Renal Failure After Open Heart Surgery. Bhat, J. Ganesh; Gluck, Melvin; Lowenstein, Jerome; Baldwin, David S. // Annals of Internal Medicine;Jun76, Vol. 84 Issue 6, p677 

    Presents information on a study that found that some patients undergoing open heart surgery had renal failure attributable to cardiopulmonary bypass. Research materials and methods; Results and discussion on the study.

  • Crush injuries and crush syndrome -- a review. Part 1: the systemic injury. Jagodzinski, Nikolas A.; Weerasinghe, Charitha; Porter, Keith // Trauma;Apr2010, Vol. 12 Issue 2, p69 

    Crush injuries can occur in large numbers following natural disasters or acts of war and terrorism. They can also occur sporadically after industrial accidents or following periods of unconsciousness from drug intoxication, anaesthesia, trauma or cerebral events. A common pathophysiological...

  • Editorial. Taylor, K. // Perfusion;1999, Vol. 14 Issue 5, p319 

    Editorial. Discusses the introduction of computer control systems into the cardio-pulmonary bypass circuit; Views on mathematical modelling of extracorporeal circulation; Evolution of automated control systems.

  • An update on perfusion safety: does the type of perfusion practice affect the rate of incidents related to cardiopulmonary bypass? Stammers, A.H.; Mejak, B.L. // Perfusion;May2001, Vol. 16 Issue 3, p189 

    Cardiopulmonary bypass (CPB) techniques vary among adult and pediatric patients undergoing cardiac surgery. This may result in a differential conduct of CPB between various aged patients. The present study reports on perfusion incidents occurring in hospitals using extracorporeal circulation. An...

  • Vacuum-assisted venous return in pediatric cardiopulmonary bypass. Berryessa, R.; Wiencek, R.; Jacobson, J.; Hollingshead, D.; Farmer, K.; Cahill, G. // Perfusion;Jan2000, Vol. 15 Issue 1, p63 

    Vacuum-assisted venous return (VAVR) has been reported to offer benefits for adults undergoing cardiopulmonary bypass (CPB), such as improved venous return, lowering priming volume (by eliminating the need to prime the venous line), and the use of smaller venous cannulae. All these benefits...

  • Affinity pump system: a new peristaltic blood pump for cardiopulmonary bypass. Jaggy, C.; Lachat, M.; Leskosek, B.; Zünd, G.; Turina, M. // Perfusion;Jan2000, Vol. 15 Issue 1, p77 

    An in vitro study has been carried out to assess the pump performance of a new peristaltic, extracorporeal displacement pump (Affinity) for cardiopulmonary bypass. The pump system consists of a pump rotor (0--110 rpm), a pump chamber, a venous reservoir with a 5/8 connecting tube and the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics