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Clinical outcome for on-pump myocardial revascularization in patients with mild renal dysfunction
M Monaco1, L Di Tommaso, M Mottola
1Department of Cardiac Surgery, University "Federico II", Naples, Italy. mariomonaco55@libero.it
Insights
Patients with mild chronic kidney disease undergoing heart surgery face increased risks. Preoperative dopamine treatment may improve long-term survival compared to postoperative treatment.
Area of Science:
- Cardiology
- Nephrology
- Cardiac Surgery
Background:
- Coronary artery disease is a leading cause of death in chronic renal failure patients.
- Mild chronic renal impairment presents unique challenges for cardiac surgery outcomes.
- This study focuses on patients with mild renal insufficiency undergoing pump myocardial revascularization.
Purpose of the Study:
- To evaluate the early and long-term outcomes of on-pump myocardial revascularization in patients with mild chronic renal impairment.
- To compare the efficacy of preoperative versus postoperative renal-dose dopamine administration.
Main Methods:
- A cohort of 67 patients with serum creatinine 1.7-2.5 mg/dl underwent on-pump myocardial revascularization between 1992 and 2000.
- Patients were divided into two groups: preoperative or postoperative renal-dose dopamine administration.
- A control group of 100 patients with normal renal function was selected for comparison.
Main Results:
- No significant differences in mortality or morbidity were observed between the two dopamine treatment groups (A vs. B).
- Group B (preoperative dopamine) showed significantly lower cardiac and respiratory complications, reduced ICU stay, and shorter length of stay (LOS).
- Survival at 12 years was significantly higher in Group B compared to Group A.
Conclusions:
- Patients with mild renal insufficiency require careful evaluation before open cardiac surgery.
- On-pump myocardial revascularization in this population is associated with increased early and long-term morbidity and mortality.
- Preoperative renal-dose dopamine may offer improved long-term survival benefits.
Background:
Coronary artery disease is the major cause of death in patients with chronic renal failure. We studied the early and long-term outcome of patients with mild chronic renal impairment, preoperative regular diuresis, and normal potassium levels having undergone pump myocardial revascularization.
Methods:
From January 1992 to December 2000, 67 patients with serum creatinine level higher than 1.7 mg/dl and less than 2.5 mg/dl underwent on-pump myocardial revascularization. The patients were divided into 2 groups and treated with renal doses of dopamine in the postoperative or preoperative period, respectively. A homogeneous group of 100 patients was selected as control.
Results:
There were no statistically significant differences in mortality and morbidity between the two groups A, while there was a significant difference in cardiac and respiratory complications, ICU stay and LOS between the A and B group in the early and long-term follow-up. Survival at 12-year follow-up is significantly higher in the B group.
Conclusions:
Patients with relatively mild renal insufficiency should be evaluated carefully for open cardiac surgery due to the significant increase in early and long-term morbidity and mortality.
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