|
|
||||||||
Ann Thorac Surg 1990;50:911-918
© 1990 The Society of Thoracic Surgeons
Divisions of Cardiovascular Anesthesiology, Cardiovascular Surgery, and Research Cardiology (Statistics), Texas Heart Institute and St. Luke's Episcopal Hospital, Houston, Texas USA
Accepted for publication August 2, 1990.
* Address reprint requests to Dr Slogoff, Cardiovascular Anesthesiology, Texas Heart Institute, PO Box 20345, Houston, TX 77225-0345.
The role of perfusion pressure and flow during cardiopulmonary bypass with moderate hypothermia and hemodilution in the development of new postoperative renal or clinically apparent cerebral dysfunction was examined in 504 adults. Cardiopulmonary bypass flow was targeted at greater than 40 mL · kg–1 · min–1 and pressure at greater than 50 mm Hg. Flows and pressures less than target occurred in 21.6% and 97.1% of patients, respectively. Fifteen patients (3.0%) suffered new renal and 13 (2.6%) new central nervous system dysfunction. Low pressure or flow during cardiopulmonary bypass, expressed in absolute values or in intensity-duration units, were not predictors of either adverse outcome. Multivariate analysis identified use of postoperative intraaortic balloon counterpulsation (p < 10–6), excessive blood loss in the ICU (p < 10–4), need for vasopressors before cardiopulmonary bypass (p < 10–4), postoperative myocardial infarction (p < 10–3), emergency reoperation (p < 0.002), excessive postoperative transfusion (p < 0.02), and chronic renal disease (p < 0.03) as independent predictors of postoperative renal dysfunction. Independent predictors of postoperative central nervous system dysfunction were cardiopulmonary resuscitation in the intensive care unit (p < 10–6), intracardiac thrombus or valve calcification (p < 0.02), and chronic renal disease (p < 0.03). Age greater than 65 years (40.7% of patients) did not predict either outcome. We conclude that failure of the native circulation during periods other than cardiopulmonary bypass rather than the flows and pressures considered here is the major cause of renal and clinically apparent central nervous system dysfunction after cardiac operations.
This article has been cited by other articles:
![]() |
M. Haase, R. Bellomo, D. Story, A. Letis, K. Klemz, G. Matalanis, S. Seevanayagam, D. Dragun, E. Seeliger, P. R. Mertens, et al. Effect of mean arterial pressure, haemoglobin and blood transfusion during cardiopulmonary bypass on post-operative acute kidney injury Nephrol. Dial. Transplant., January 1, 2012; 27(1): 153 - 160. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Ranucci, S. Aronson, W. Dietrich, C. M. Dyke, A. Hofmann, K. Karkouti, M. Levi, G. J. Murphy, F. W. Sellke, L. Shore-Lesserson, et al. Patient blood management during cardiac surgery: Do we have enough evidence for clinical practice? J. Thorac. Cardiovasc. Surg., August 1, 2011; 142(2): 249.e1 - 249.e32. [Full Text] [PDF] |
||||
![]() |
M. Siepe, T. Pfeiffer, A. Gieringer, S. Zemann, C. Benk, C. Schlensak, and F. Beyersdorf Increased systemic perfusion pressure during cardiopulmonary bypass is associated with less early postoperative cognitive dysfunction and delirium Eur J Cardiothorac Surg, July 1, 2011; 40(1): 200 - 207. [Abstract] [Full Text] [PDF] |
||||
![]() |
R. K. P. Adluri, A. V. Singh, J. Skoyles, T. Hitch, A. Robins, M. Baker, and I. M. Mitchell Effect of increased pump flow on hepatic blood flow and systemic inflammatory response following on-pump coronary artery bypass grafting Perfusion, September 1, 2010; 25(5): 293 - 303. [Abstract] [PDF] |
||||
![]() |
U. Goebel, M. Siepe, C. I. Schwer, D. Schibilsky, K. Foerster, J. Neumann, T. Wiech, H.-J. Priebe, C. Schlensak, and T. Loop Inhaled Carbon Monoxide Prevents Acute Kidney Injury in Pigs After Cardiopulmonary Bypass by Inducing a Heat Shock Response Anesth. Analg., July 1, 2010; 111(1): 29 - 37. [Abstract] [Full Text] [PDF] |
||||
![]() |
G. S. Murphy, E. A. Hessel II, and R. C. Groom Optimal Perfusion During Cardiopulmonary Bypass: An Evidence-Based Approach Anesth. Analg., May 1, 2009; 108(5): 1394 - 1417. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. Maier, W. R. Hasibeder, C. Hengl, W. Pajk, B. Schwarz, J. Margreiter, H. Ulmer, J. Engl, and H. Knotzer Effects of phenylephrine on the sublingual microcirculation during cardiopulmonary bypass Br. J. Anaesth., April 1, 2009; 102(4): 485 - 491. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. H. Rosner, D. Portilla, and M. D. Okusa Analytic Reviews: Cardiac Surgery as a Cause of Acute Kidney Injury: Pathogenesis and Potential Therapies J Intensive Care Med, January 1, 2008; 23(1): 3 - 18. [Abstract] [PDF] |
||||
![]() |
S. Aronson, M. L. Fontes, Y. Miao, D. T. Mangano, and for the Investigators of the Multicenter Study of Risk Index for Perioperative Renal Dysfunction/Failure: Critical Dependence on Pulse Pressure Hypertension Circulation, February 13, 2007; 115(6): 733 - 742. [Abstract] [Full Text] [PDF] |
||||
![]() |
R. H. Mehta, J. D. Grab, S. M. O'Brien, C. R. Bridges, J. S. Gammie, C. K. Haan, T. B. Ferguson, E. D. Peterson, and for the Society of Thoracic Surgeons National Card Bedside Tool for Predicting the Risk of Postoperative Dialysis in Patients Undergoing Cardiac Surgery Circulation, November 21, 2006; 114(21): 2208 - 2216. [Abstract] [Full Text] [PDF] |
||||
![]() |
C. W. Hogue Jr, C. A. Palin, and J. E. Arrowsmith Cardiopulmonary Bypass Management and Neurologic Outcomes: An Evidence-Based Appraisal of Current Practices Anesth. Analg., July 1, 2006; 103(1): 21 - 37. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. H. Rosner and M. D. Okusa Acute Kidney Injury Associated with Cardiac Surgery Clin. J. Am. Soc. Nephrol., January 1, 2006; 1(1): 19 - 32. [Abstract] [Full Text] [PDF] |
||||
![]() |
I. Bahar, A. Akgul, M. A. Ozatik, K. M Vural, A. E Demirbag, M. Boran, and O. Tasdemir Acute renal failure following open heart surgery: risk factors and prognosis Perfusion, December 1, 2005; 20(6): 317 - 322. [Abstract] [PDF] |
||||
![]() |
B. G. Loef, A. H. Epema, T. D. Smilde, R. H. Henning, T. Ebels, G. Navis, and C. A. Stegeman Immediate Postoperative Renal Function Deterioration in Cardiac Surgical Patients Predicts In-Hospital Mortality and Long-Term Survival J. Am. Soc. Nephrol., January 1, 2005; 16(1): 195 - 200. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Ranucci, G. Soro, N. Barzaghi, A. Locatelli, G. Giordano, A. Vavassori, A. Manzato, C. Melchiorri, T. Bove, G. Juliano, et al. Fenoldopam Prophylaxis of Postoperative Acute Renal Failure in High-Risk Cardiac Surgery Patients Ann. Thorac. Surg., October 1, 2004; 78(4): 1332 - 1337. [Abstract] [Full Text] [PDF] |
||||
![]() |
N. M. Schwann, J. C. Horrow, M. D. Strong III, D. Chamchad, A. Guerraty, and A. S. Wechsler Does Off-Pump Coronary Artery Bypass Reduce the Incidence of Clinically Evident Renal Dysfunction After Multivessel Myocardial Revascularization? Anesth. Analg., October 1, 2004; 99(4): 959 - 964. [Abstract] [Full Text] [PDF] |
||||
![]() |
O. V. Carcoana, J. P. Mathew, E. Davis, D. W. Byrne, J. P. Hayslett, R. L. Hines, and S. Garwood Mannitol and Dopamine in Patients Undergoing Cardiopulmonary Bypass: A Randomized Clinical Trial Anesth. Analg., November 1, 2003; 97(5): 1222 - 1229. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. Provenchere, G. Plantefeve, G. Hufnagel, E. Vicaut, C. de Vaumas, J.-B. Lecharny, J.-P. Depoix, F. Vrtovsnik, J.-M. Desmonts, and I. Philip Renal Dysfunction After Cardiac Surgery with Normothermic Cardiopulmonary Bypass: Incidence, Risk Factors, and Effect on Clinical Outcome Anesth. Analg., May 1, 2003; 96(5): 1258 - 1264. [Abstract] [Full Text] [PDF] |
||||
![]() |
C. S. Rinder, M. Fontes, J. P. Mathew, H. M. Rinder, and B. R. Smith Neutrophil CD11b upregulation during cardiopulmonary bypass is associated with postoperative renal injury Ann. Thorac. Surg., March 1, 2003; 75(3): 899 - 905. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. J. Albahrani, M. Swaminathan, B. Phillips-Bute, P. K. Smith, M. F. Newman, J. P. Mathew, and M. Stafford-Smith Postcardiac Surgery Complications: Association of Acute Renal Dysfunction and Atrial Fibrillation Anesth. Analg., March 1, 2003; 96(3): 637 - 643. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. Aronson, D. Boisvert, and W. Lapp Isolated Systolic Hypertension Is Associated with Adverse Outcomes from Coronary Artery Bypass Grafting Surgery Anesth. Analg., May 1, 2002; 94(5): 1079 - 1084. [Abstract] [Full Text] [PDF] |
||||
![]() |
U. S. Boston, J. M. Slater, T. A. Orszulak, and D. J. Cook Hierarchy of regional oxygen delivery during cardiopulmonary bypass Ann. Thorac. Surg., January 1, 2001; 71(1): 260 - 264. [Abstract] [Full Text] [PDF] |
||||
![]() |
C. L. DAVIS, A. T. KAUSZ, R. A. ZAGER, E. D. KHARASCH, and R. P. COCHRAN Acute Renal Failure after Cardiopulmonary Bypass Is Related to Decreased Serum Ferritin Levels J. Am. Soc. Nephrol., November 1, 1999; 10(11): 2396 - 2402. [Abstract] [Full Text] |
||||
![]() |
K. A. Eagle, R. A. Guyton, R. Davidoff, G. A. Ewy, J. Fonger, T. J. Gardner, J. P. Gott, H. C. Herrmann, R. A. Marlow, W. C. Nugent, et al. ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/ American Heart Association task force on Practice Guidelines (Committee to revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery) J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1262 - 1347. [Full Text] [PDF] |
||||
![]() |
D. P. Taggart, S. M. Browne, P. W. Halligan, and D. T. Wade IS CARDIOPULMONARY BYPASS STILL THE CAUSE OF COGNITIVE DYSFUNCTION AFTER CARDIAC OPERATIONS? J. Thorac. Cardiovasc. Surg., September 1, 1999; 118(3): 414 - 420. [Abstract] [Full Text] [PDF] |
||||
![]() |
W.-S. Suen, C.-K. Mok, S.-W. Chiu, K.-L. Cheung, W.-T. Lee, D. Cheung, S.-R. Das, and G.-W. He Risk Factors for Development of Acute Renal Failure (ARF) Requiring Dialysis in Patients Undergoing Cardiac Surgery Angiology, September 1, 1998; 49(9): 789 - 800. [Abstract] [PDF] |
||||
![]() |
W. Plochl, D. J. Cook, T. A. Orszulak, and R. C. Daly Critical cerebral perfusion pressure during tepid heart operations in dogs Ann. Thorac. Surg., July 1, 1998; 66(1): 118 - 123. [Abstract] [Full Text] [PDF] |
||||
![]() |
R. A. Perugini, R. K. Orr, D. Porter, E. M. Dumas, and B. S. Maini Gastrointestinal Complications Following Cardiac Surgery: An Analysis of 1477 Cardiac Surgery Patients Arch Surg, April 1, 1997; 132(4): 352 - 357. [Abstract] [PDF] |
||||
![]() |
C. O'Dwyer, L. C. Woodson, B. P. Conroy, C. Y. Lin, D. J. Deyo, T. Uchida, and W. E. Johnston Regional Perfusion Abnormalities With Phenylephrine During Normothermic Bypass Ann. Thorac. Surg., March 1, 1997; 63(3): 728 - 735. [Abstract] [Full Text] |
||||
![]() |
A. Jeppsson, R. Ekroth, K. Kirno, I. Milocco, B. Nilsson, F. Nilsson, S. Svensson, and J. Wernerman INSULIN AND AMINO ACID INFUSION AFTER CARDIAC OPERATIONS: EFFECTS ON SYSTEMIC AND RENAL PERFUSION J. Thorac. Cardiovasc. Surg., March 1, 1997; 113(3): 594 - 602. [Abstract] [Full Text] |
||||
![]() |
J. P. Gold, M. E. Charlson, P. Williams-Russo, T. P. Szatrowski, J. C. Peterson, P. A. Pirraglia, G. S. Hartman, F. S. F. Yao, J. P. Hollenberg, D. Barbut, et al. IMPROVEMENT OF OUTCOMES AFTER CORONARY ARTERY BYPASS: A randomized trial comparing intraoperative high versus low mean arterial pressure J. Thorac. Cardiovasc. Surg., November 1, 1995; 110(5): 1302 - 1314. [Abstract] [Full Text] |
||||
![]() |
G. Zanardo, P. Michielon, A. Paccagnella, P. Rosi, M. Calo, V. Salandin, A. Da Ros, F. Michieletto, and G. Simini Acute renal failure in the patient undergoing cardiac operationPrevalence, mortality rate, and main risk factors J. Thorac. Cardiovasc. Surg., June 1, 1994; 107(6): 1489 - 1495. [Abstract] [Full Text] |
||||
![]() |
R. T. Baldwin, S. Slogoff, G. P. Noon, M. Sekela, O. H. Frazier, S. K. Edelman, and W. K. Vaughn A model to predict survival at time of postcardiotomy intraaortic balloon pump insertion Ann. Thorac. Surg., April 1, 1993; 55(4): 908 - 913. [Abstract] [PDF] |
||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |