Asian Annals
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Antonino Roscitano
Umberto Benedetto
Fabio Capuano
Riccardo Sinatra
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ORIGINAL ARTICLE

Intraoperative Continuous Venovenous Hemofiltration during Coronary Surgery

Antonino Roscitano, MD, Umberto Benedetto, MD, Massimo Goracci, Fabio Capuano, MD, Remo Lucani, MD1, Riccardo Sinatra, MD

Division of Cardiac Surgery
1 Division of Nephrology Sapienza University of Rome S. Andrea Hospital, Rome, Italy

Antonino Roscitano, MD Tel: +39 0633 775310 Fax: +39 0633 775483 Email: aroscitano{at}katamail.com, Ospedale S. Andrea, University of Rome "La Sapienza", via di Grottarossa 1035, 00189 Rome, Italy.

ABSTRACT

Postoperative continuous venovenous hemofiltration decreases acute renal failure in patients with moderate renal dysfunction undergoing coronary artery bypass grafting, but it prolongs intensive care unit stay. We developed a simple method to connect a hemofiltration machine to the cardiopulmonary bypass system. To evaluate the benefit of intraoperative hemofiltration, 124 consecutive patients (mean age, 67 ± 6 years) with moderate renal dysfunction were studied. Surgery was preformed between January 2005 and May 2007. On-pump coronary artery bypass with hemofiltration was carried out in 40 patients (group A), 44 had on-pump coronary artery bypass without hemofiltration (group B), and 40 had off-pump coronary artery bypass (group C). Postoperative acute renal failure was defined as either renal failure requiring dialysis or ≥50% decline from the baseline glomerular filtration rate but not requiring dialysis. The 3 groups had similar demographic data and preoperative renal function. After adjusting for covariates and propensity scores, multivariate analysis showed that intraoperative hemofiltration and off-pump surgery protected postoperative renal function. Independent risk factors for postoperative renal dysfunction were age >70 years, left ventricular ejection fraction <35%, and the preoperative glomerular filtration rate.

Key Words: Cardiopulmonary Bypass • Coronary Artery Bypass • Hemofiltration • Kidney Failure • Acute

Asian Cardiovasc Thorac Ann 2009; 17:462-466
© 2009 by SAGE Publications
DOI: 10.1177/0218492309348504




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