Investigation of the Effect of Pulsatile and Nonpulsatile Flow on Kidney in Coronary Surgery With NIRS

Examination of Kidney with Pulsatil and Nonpulsatile Flow with NIRS

Authors

  • Ferhat Borulu Department of Cardiovascular Surgery, Atatürk University Faculty of Medicine, Erzurum, Turkey
  • Muhammet Onur Hanedan Department of Cardiovascular Surgery, University of Health Sciences Ahi Evren Education and Researches Hospital, Trabzon, Turkey
  • Ceyhun Coşkun Department of Cardiovascular Surgery, Yalvaç Public Hospital, Isparta, Turkey
  • İzzet Emir Department of Cardiovascular Surgery, Erzincan University, Faculty of Medicine, Erzincan, Turkey
  • İlker Mataraci Department of Cardiovascular Surgery, University of Health Sciences Ahi Evren Education and Researches Hospital, Trabzon, Turkey

DOI:

https://doi.org/10.1532/hsf.2341

Keywords:

inflammatory response syndrome, Coronary Surgery

Abstract

Background: Acute renal insufficiency is a significant cause of morbidity and mortality after coronary artery bypass grafting performed with cardiopulmonary bypass. Functional near-infrared spectroscopy (fNIRS) is an emerging brain-imaging technique that can be used to detect organ perfusions in adults. This study aims to determine the effects of pulsatile and nonpulsatile flow on renal circulation by using functional near-infrared spectroscopy and
biochemical markers.

Methods: Forty patients, who had undergone isolated CABG between March 2014 and July 2014 in the authors’ clinic, were included in the study. Patients were divided in the pulsatile and nonpulsatile groups by
simple randomization.

Results: Urine outputs statistically were higher in the pulsatile group, during CPB (P = .045). Renal perfusion measurements via fNIRS intra-operatively statistically were parallel between the groups. When we compared biochemical markers within the groups, in the nonpulsatile group, creatinin statistically is higher on the postoperative first day
(P = .003), and BUN statistically is higher on the postoperative first (P = .015), second (P = .001), and fifth
(P = .020) days, according to preoperative value. In the pulsatile group, only the postoperative second day BUN is
higher (P = .007).

Conclusion: fNIRS is being used to track cerebral functions. During operation, it also provides a correct observation for blood feeding of somatic organs, such as the kidneys, but it requires more clinical study to be accepted as routine.

References

Bayram H, Erer D, Iriz E, HakanZor M, Gulbahar O, Ozdogan ME. 2012. Comparison of the effects of pulsatile cardiopulmonary bypass, nonpulsatile cardiopulmonary bypass and off-pump coronary artery bypass grafting on the respiratory system and serum carbonyl. Perfusion. 27:378–85.

Conlon PJ, Stafford-Smith M, White WD, et al. 1999. Acute renal failure following cardiac

surgery. Nephrol Dial Transplant 14:1158–62.

Diaz GC, Moitra V, Sladen RN. 2008. Hepatic and renal protection during cardiac surgery. Anesthesiol Clin. 26:565-90.

Fuiano G, Mancuso D, Indolfi C, et al. 2005. Early detection of progressive renal dysfunction in patients with coronary artery disease. Kidney Int 68:2773-2780.

Grover FL, Shroyer AL, Hammermeister K, et al. 2001. A decade’s experience with quality improvement in cardiac surgery using the Veterans Affairs and Society of Thoracic Surgeons national databases. Ann Surg 234:464-472; discussion, 472-464.

Khilji SA, Khan AH. 2004. Acute renal failure after cardiopulmonary bypass surgery. J Ayub Med Coll Abbottabad. 16:25-8.

Markham DW, Fu Q, Palmer MD, Drazner MH, Meyer DM, Bethea BT, Hastings JL, Fujimoto N, Shibata S, Levine BD. 2013. Sympathetic neural and hemodynamic responses to upright tilt in patients with pulsatile and nonpulsatile left ventricular assist devices. Circ Heart Fail. Mar;6(2):293-9.

Mohammadzadeh A, Jafari N, Hasanpour M, Sahandifar S, Ghafari M, Alaei V. 2013. Effects of pulsatile perfusion during cardiopulmonary bypass on biochemical markers and kidney function in patients undergoing cardiac surgeries. Am J Cardiovasc Dis Aug 16;3(3):158-62.

Onorati F, Presta P, Fuiano G, Mastroroberto P, Comi N, Pezzo F, Tozzo C, Renzulli A. 2007. A randomized trial of pulsatile perfusion using an intra-aortic balloon pump versus nonpulsatile perfusion on short-term changes in kidney function during cardiopulmonary bypass during myocardial reperfusion. Am J Kidney Dis Aug;50(2):229-38.

Paparella D, Yau TM, Young E. 2002. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg Feb;21(2):232-44.

Ricci Z, Haiberger R, Tofani L, Romagnoli S, Favia I, Cogo P. 2015. Multisite Near Infrared Spectroscopy During Cardiopulmonary Bypass in Pediatric Patients. Artif Organs. Jul;39(7):584-90.

Sahin V, Akpinar MB, Sevim E, Uyar IS, Abacilar AF, Uc H, Tetik F, Damar E, Okur FF, Alayunt EA. 2015. Preoperative CRP levels is not predictive early renal dysfunction after coronary artery bypass surgery. Int J Clin Exp Med Mar 15;8(3):4146-51.

Sai L, Zhou X, Ding XP, Fu G, Sang B. 2014. Detecting concealed information using functional near-infrared spectroscopy, Brain Topogr. 27(5), 652–662.

Sievert A, Sistino J. 2012. A meta-analysis of renal benefits to pulsatile perfusion in cardiac surgery. J Extra Corpor Technol Mar;44(1):10-4.

Toraman F, Özgen SU, Arıtürk C, Julide S, Erkek E, Güçlü P, Ökten M, Güllü Ü, Şenay Ş, Tektürk MB, Karabulut H, Alhan C. 2012. Is Hepatic and Renal (somatic) OxygenSaturation Followed by NIRS Method during Extracorporeal Circulation in Adult Cardiac Surgery? Journal of Acıbadem University Health Sciences. July Cover 3-Number 3,164-169.

Published

2020-06-12

How to Cite

Borulu, F., Hanedan, M. O., Coşkun, C., Emir, İzzet, & Mataraci, İlker. (2020). Investigation of the Effect of Pulsatile and Nonpulsatile Flow on Kidney in Coronary Surgery With NIRS: Examination of Kidney with Pulsatil and Nonpulsatile Flow with NIRS. The Heart Surgery Forum, 23(4), E401-E406. https://doi.org/10.1532/hsf.2341

Issue

Section

Article