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Eur J Cardiothorac Surg 2008;33:138. doi:10.1016/j.ejcts.2007.10.008
Copyright © 2008, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Letters to the Editor

Renal haemodynamics during cardiopulmonary bypass

Guillermo Lema*, Roberto Canessa

Department of Anaesthesiology, Pontificia Universidad Católica de Chile, Santiago, Chile

Received 7 September 2007; accepted 11 October 2007.

* Corresponding author. Address: P.O. Box 114-D, Marcoleta 367, Santiago, Chile. Tel.: +56 2 6863415; fax: +56 2 6394409. (Email: glema{at}med.puc.cl).

Key Words: Cardiac surgery • Renal function • Cardiopulmonary bypass

I have read with great interest the work by Simon et al. [1] and I would like to add comments to the discussion.

For many years most of the early and late complications of this surgery have been associated with the use of CPB, in patients with abnormal preoperative renal dysfunction, however in this study no association was found between CPB time and clamp-time with the outcomes studied.

The authors claim that some of the factors presumably affecting renal function on CPB could be the ‘inadequate renal perfusion’. This fact has been transmitted over time, based on studies from the early years of cardiac surgery [2]. This is probably not the case nowadays.

Studies from our group in coronary, valvular and paediatric patients undergoing surgery with CPB have shown, that contrary to previous reports, glomerular filtration rate, and effective renal plasma flow (ERPF) (inulin and I 131-Hipuran clearances) are well preserved during CPB [3,4]. Moreover ERPF flow increases in some patients during hypothermic CPB, probably due to lower renal vascular resistance, low viscosity and systemic hypothermia among others. ERPF is also significantly reduced pre-bypass. We can also speculate that hypoperfusion may occur in the postoperative period, due to the rise in catecholamine levels and surgical stress. It is reasonable then to think that the prebypass and the postoperative period are the most vulnerable times affecting renal haemodynamics, rather than CPB.

Whether pulsatile flow is beneficial during CPB is still speculative as no clear data have been shown in the literature so far [5].

Footnotes

\#9734; Grant FONDECYT 1030645-2003

References

  1. Simon C, Luciani R, Capuano F, Miceli A, Roscitano A, Tonelli E, Sinatra R. Mild and moderate renal dysfunction: impact on short-term outcome. Eur J Cardio Thor Surg 2007;32:286-290.[Abstract/Free Full Text]
  2. Porter GA, Kloster FE, Herr RJ, Starr A, Griswold HE, Kimsey J. Renal complications associated with valve replacement surgery. J Thorac Cardiovasc Surg 1967;53:145-152.[Medline]
  3. Lema G, Urzua J, Jalil R, Canessa R, Moran S, Irarrázaval MJ, Zalaquett R, Orellana P. Renal protection in patients undergoing cardiopulmonary bypass with preoperative abnormal renal function. Anesth Analg 1998;86:3-8.[Abstract]
  4. Lema G, Vogel A, Canessa R, Jalil R, Carvajal C, Becker P, Jaque MP. Renal function and cardiopulmonary bypass in pediatric cardiac surgical patients. Pediatr Nephrol 2006;21:1446-1451.[CrossRef][Medline]
  5. Abramov D, Tamariz M, Serrick CI, Sharp E, noel D, Harwood D, Christakis GT, Goldman BS. The influence of cardiopulmonary bypass flow characteristics on the clinical outcome of 1820 coronary bypass patients. Can J Cardiol 2003;19(3):237-243.[Medline]




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Right arrow Extracorporeal circulation

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