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DOI: 10.1055/s-0037-1598732
Kidney Protection during CABG: No Effect of Pulsatile versus Nonpulsatile MECC
Publication History
Publication Date:
03 February 2017 (online)
Objectives: Renal dysfunction is commonly seen after CABG. Novel urinary biomarkers have been introduced for early detection of renal structural damage. The effect of pulsatile perfusion mode in minimized CPB on urinary biomarkers has not yet been studied.
Methods: Forty patients with normal kidney function scheduled for elective or urgent multivessel CABG were randomized to either pulsatile (pp) or continuous (cp) perfusion mode. Pulsatility was accomplished using the MINI.SYSTEM 1.0 (Medos AG) containing the Deltastream DP3 diagonal flow pump, which enables pump flow variations of 5.000 rpm at pulse rates between 40 and 90 bpm. For the study, pulse rate was set at 40 bpm with a 25% systolic rise in steepness. Pulsatile mode was switched on during cardiac arrest. Levels of Kidney Injury Molecule-1 (KIM1), Neutrophil gelatinase-associated lipocalin (NGAL), Liver-type fatty acid-binding protein (L-FABP), and Alpha glutathione S transferase (αGST) were determined in the patient’s urine at baseline and up to 72 hours postoperatively.
Results: The groups were homogenous in terms of gender (pp: 19 m, 3 f; cp: 15 m, 3 f), age (pp: 64 ± 10 years, cp: 67 ± 8 years), and bypass grafts per patient (pp: 3.5 ± 1.1, cp: 3.6 ± 1.0). Perfusion and cross clamp times were comparable (pp: 102 ± 19 minutes and 57 ± 12 minutes; cp: 108 ± 30 minutes and 55 ± 13 minutes). Pulsatile mode created a mean pulse pressure amplitude of 24.0 ± 1.8 mm Hg leaving the mean arterial pressure unaffected (pp: 62.7 ± 4.2 mm Hg; cp: 66.4 ± 3.0 mm Hg, p = 0.066). Pulsatile mode did not interfere with surgery. None of the patients revealed signs of renal failure after surgery. Levels of urinary biomarkers were elevated after surgery but did not exhibit differences between the groups (p values KIM1: 0.964; NGAL: 0.547; L-FABP: 0.303; αGST: 0.436).
Conclusion: Adding pulsatility to minimized extracorporeal circulation had no measurable effect on urinary biomarkers in this study on patients with normal kidney function. However, it could be shown that pulsatility can easily be implemented during CABG with MECC. Further research is warranted with optimized pulse settings on patients with pre-existing renal impairment.