Coronary artery bypass surgery in patients with end stage existing renal disease

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Saphenous Vein Graft Disease
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]

ACCF/AHA Guidelines for Patients with Renal Dysfunction[1]

Class IIb

"1. In patients with preoperative renal dysfunction (creatinine clearance <60 mL/min), off-pump CABG may be reasonable to reduce the risk of acute kidney injury (AKI).[2][3][4][5][6] (Level of Evidence: B)"

"2. In patients with preexisting renal dysfunction undergoing on-pump CABG, maintenance of a perioperative hematocrit greater than 19% and mean arterial pressure greater than 60 mm Hg may be reasonable. (Level of Evidence: C)"

"3. In patients with preexisting renal dysfunction, a delay of surgery after coronary angiography may be reasonable until the effect of radiographic contrast material on renal function is assessed.[7][8][9] (Level of Evidence: B)"

"4. The effectiveness of pharmacological agents to provide renal protection during cardiac surgery is uncertain.[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] (Level of Evidence: B)"

ACCF/AHA Guidelines for CABG in Patients with End Stage Renal Disease[1]

Class III: HARM

"1. CABG should not be performed in patients with end-stage renal disease whose life expectancy is limited by noncardiac issues. (Level of Evidence: C)"

Class IIb

"1. CABG to improve survival rate may be reasonable in patients with end stage renal disease undergoing CABG for left main coronary artery stenosis of greater than or equal to 50%.[32] (Level of Evidence: C)"

"2. CABG to improve survival rate or to relieve angina despite GDMT may be reasonable for patients with end-stage renal disease with significant stenoses (≥70%) in 3 major vessels or in the proximal LAD artery plus 1 other major vessel, regardless of LV systolic function.[33] (Level of Evidence: B)"

Guidelines Resources

  • 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[1]

References

  1. ↑ 1.0 1.1 1.2 Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG; et al. (2011). "2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0b013e31823c074e. PMID 22064599.
  2. ↑ Ascione R, Nason G, Al-Ruzzeh S, Ko C, Ciulli F, Angelini GD (2001). "Coronary revascularization with or without cardiopulmonary bypass in patients with preoperative nondialysis-dependent renal insufficiency". The Annals of Thoracic Surgery. 72 (6): 2020–5. PMID 11789787. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  3. ↑ Chukwuemeka A, Weisel A, Maganti M, Nette AF, Wijeysundera DN, Beattie WS, Borger MA (2005). "Renal dysfunction in high-risk patients after on-pump and off-pump coronary artery bypass surgery: a propensity score analysis". The Annals of Thoracic Surgery. 80 (6): 2148–53. doi:10.1016/j.athoracsur.2005.06.015. PMID 16305860. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  4. ↑ Di Mauro M, Gagliardi M, Iacò AL, Contini M, Bivona A, Bosco P, Gallina S, Calafiore AM (2007). "Does off-pump coronary surgery reduce postoperative acute renal failure? The importance of preoperative renal function". The Annals of Thoracic Surgery. 84 (5): 1496–502. doi:10.1016/j.athoracsur.2007.05.054. PMID 17954051. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  5. ↑ Nigwekar SU, Kandula P, Hix JK, Thakar CV (2009). "Off-pump coronary artery bypass surgery and acute kidney injury: a meta-analysis of randomized and observational studies". American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 54 (3): 413–23. doi:10.1053/j.ajkd.2009.01.267. PMID 19406542. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  6. ↑ Sajja LR, Mannam G, Chakravarthi RM, Sompalli S, Naidu SK, Somaraju B, Penumatsa RR (2007). "Coronary artery bypass grafting with or without cardiopulmonary bypass in patients with preoperative non-dialysis dependent renal insufficiency: a randomized study". The Journal of Thoracic and Cardiovascular Surgery. 133 (2): 378–88. doi:10.1016/j.jtcvs.2006.09.028. PMID 17258568. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  7. ↑ Del Duca D, Iqbal S, Rahme E, Goldberg P, de Varennes B (2007). "Renal failure after cardiac surgery: timing of cardiac catheterization and other perioperative risk factors". The Annals of Thoracic Surgery. 84 (4): 1264–71. doi:10.1016/j.athoracsur.2007.05.016. PMID 17888981. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  8. ↑ Medalion B, Cohen H, Assali A, Vaknin Assa H, Farkash A, Snir E, Sharoni E, Biderman P, Milo G, Battler A, Kornowski R, Porat E (2010). "The effect of cardiac angiography timing, contrast media dose, and preoperative renal function on acute renal failure after coronary artery bypass grafting". The Journal of Thoracic and Cardiovascular Surgery. 139 (6): 1539–44. doi:10.1016/j.jtcvs.2009.08.042. PMID 19969314. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  9. ↑ Ranucci M, Ballotta A, Kunkl A, De Benedetti D, Kandil H, Conti D, Mollichelli N, Bossone E, Mehta RH (2008). "Influence of the timing of cardiac catheterization and the amount of contrast media on acute renal failure after cardiac surgery". The American Journal of Cardiology. 101 (8): 1112–8. doi:10.1016/j.amjcard.2007.12.011. PMID 18394443. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  10. ↑ Adabag AS, Ishani A, Bloomfield HE, Ngo AK, Wilt TJ (2009). "Efficacy of N-acetylcysteine in preventing renal injury after heart surgery: a systematic review of randomized trials". European Heart Journal. 30 (15): 1910–7. doi:10.1093/eurheartj/ehp053. PMC 2719697. PMID 19282300. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  11. ↑ Amar D, Fleisher M (2001). "Diltiazem treatment does not alter renal function after thoracic surgery". Chest. 119 (5): 1476–9. PMID 11348956. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  12. ↑ Caimmi PP, Pagani L, Micalizzi E, Fiume C, Guani S, Bernardi M, Parodi F, Cordero G, Fregonara M, Kapetanakis E, Panella M, Degasperis C (2003). "Fenoldopam for renal protection in patients undergoing cardiopulmonary bypass". Journal of Cardiothoracic and Vascular Anesthesia. 17 (4): 491–4. PMID 12968238. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  13. ↑ Cogliati AA, Vellutini R, Nardini A, Urovi S, Hamdan M, Landoni G, Guelfi P (2007). "Fenoldopam infusion for renal protection in high-risk cardiac surgery patients: a randomized clinical study". Journal of Cardiothoracic and Vascular Anesthesia. 21 (6): 847–50. doi:10.1053/j.jvca.2007.02.022. PMID 18068064. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  14. ↑ El-Hamamsy I, Stevens LM, Carrier M, Pellerin M, Bouchard D, Demers P, Cartier R, Page P, Perrault LP (2007). "Effect of intravenous N-acetylcysteine on outcomes after coronary artery bypass surgery: a randomized, double-blind, placebo-controlled clinical trial". The Journal of Thoracic and Cardiovascular Surgery. 133 (1): 7–12. doi:10.1016/j.jtcvs.2006.05.070. PMID 17198774. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  15. ↑ Fansa I, Gol M, Nisanoglu V, Yavas S, Iscan Z, Tasdemir O (2003). "Does diltiazem inhibit the inflammatory response in cardiopulmonary bypass?". Medical Science Monitor : International Medical Journal of Experimental and Clinical Research. 9 (4): PI30–6. PMID 12709682. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  16. ↑ Fischer UM, Tossios P, Mehlhorn U (2005). "Renal protection by radical scavenging in cardiac surgery patients". Current Medical Research and Opinion. 21 (8): 1161–4. doi:10.1185/030079905X53289. PMID 16083524. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  17. ↑ Friedrich JO, Adhikari N, Herridge MS, Beyene J (2005). "Meta-analysis: low-dose dopamine increases urine output but does not prevent renal dysfunction or death". Annals of Internal Medicine. 142 (7): 510–24. PMID 15809463. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  18. ↑ Haase M, Haase-Fielitz A, Bagshaw SM, Reade MC, Morgera S, Seevenayagam S, Matalanis G, Buxton B, Doolan L, Bellomo R (2007). "Phase II, randomized, controlled trial of high-dose N-acetylcysteine in high-risk cardiac surgery patients". Critical Care Medicine. 35 (5): 1324–31. doi:10.1097/01.CCM.0000261887.69976.12. PMID 17414730. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  19. ↑ Ip-Yam PC, Murphy S, Baines M, Fox MA, Desmond MJ, Innes PA (1994). "Renal function and proteinuria after cardiopulmonary bypass: the effects of temperature and mannitol". Anesthesia and Analgesia. 78 (5): 842–7. PMID 8160980. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  20. ↑ Landoni G, Biondi-Zoccai GG, Tumlin JA, Bove T, De Luca M, Calabrò MG, Ranucci M, Zangrillo A (2007). "Beneficial impact of fenoldopam in critically ill patients with or at risk for acute renal failure: a meta-analysis of randomized clinical trials". American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 49 (1): 56–68. doi:10.1053/j.ajkd.2006.10.013. PMID 17185146. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  21. ↑ Landoni G, Biondi-Zoccai GG, Marino G, Bove T, Fochi O, Maj G, Calabrò MG, Sheiban I, Tumlin JA, Ranucci M, Zangrillo A (2008). "Fenoldopam reduces the need for renal replacement therapy and in-hospital death in cardiovascular surgery: a meta-analysis". Journal of Cardiothoracic and Vascular Anesthesia. 22 (1): 27–33. doi:10.1053/j.jvca.2007.07.015. PMID 18249327. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  22. ↑ Murphy MB, Murray C, Shorten GD (2001). "Fenoldopam: a selective peripheral dopamine-receptor agonist for the treatment of severe hypertension". The New England Journal of Medicine. 345 (21): 1548–57. doi:10.1056/NEJMra010253. PMID 11794223. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  23. ↑ Nigwekar SU, Hix JK (2009). "The role of natriuretic peptide administration in cardiovascular surgery-associated renal dysfunction: a systematic review and meta-analysis of randomized controlled trials". Journal of Cardiothoracic and Vascular Anesthesia. 23 (2): 151–60. doi:10.1053/j.jvca.2008.11.007. PMID 19167908. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  24. ↑ Piper SN, Kumle B, Maleck WH, Kiessling AH, Lehmann A, Röhm KD, Suttner SW, Boldt J (2003). "Diltiazem may preserve renal tubular integrity after cardiac surgery". Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie. 50 (3): 285–92. doi:10.1007/BF03017799. PMID 12620953. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  25. ↑ Ranucci M, Soro G, Barzaghi N, Locatelli A, Giordano G, Vavassori A, Manzato A, Melchiorri C, Bove T, Juliano G, Uslenghi MF (2004). "Fenoldopam prophylaxis of postoperative acute renal failure in high-risk cardiac surgery patients". The Annals of Thoracic Surgery. 78 (4): 1332–7, discussion 1337–8. doi:10.1016/j.athoracsur.2004.02.065. PMID 15464494. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  26. ↑ Ranucci M, De Benedetti D, Bianchini C, Castelvecchio S, Ballotta A, Frigiola A, Menicanti L (2010). "Effects of fenoldopam infusion in complex cardiac surgical operations: a prospective, randomized, double-blind, placebo-controlled study". Minerva Anestesiologica. 76 (4): 249–59. PMID 20332738. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  27. ↑ Sirivella S, Gielchinsky I, Parsonnet V (2000). "Mannitol, furosemide, and dopamine infusion in postoperative renal failure complicating cardiac surgery". The Annals of Thoracic Surgery. 69 (2): 501–6. PMID 10735688. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  28. ↑ Tumlin JA, Finkel KW, Murray PT, Samuels J, Cotsonis G, Shaw AD (2005). "Fenoldopam mesylate in early acute tubular necrosis: a randomized, double-blind, placebo-controlled clinical trial". American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 46 (1): 26–34. PMID 15983954. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  29. ↑ Vesely DL (2003). "Natriuretic peptides and acute renal failure". American Journal of Physiology. Renal Physiology. 285 (2): F167–77. doi:10.1152/ajprenal.00259.2002. PMID 12842858. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  30. ↑ Wang G, Bainbridge D, Martin J, Cheng D (2011). "N-acetylcysteine in cardiac surgery: do the benefits outweigh the risks? A meta-analytic reappraisal". Journal of Cardiothoracic and Vascular Anesthesia. 25 (2): 268–75. doi:10.1053/j.jvca.2010.04.022. PMID 20638862. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  31. ↑ Young EW, Diab A, Kirsh MM (1998). "Intravenous diltiazem and acute renal failure after cardiac operations". The Annals of Thoracic Surgery. 65 (5): 1316–9. PMID 9594859. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  32. ↑ Hemmelgarn BR, Southern D, Culleton BF, Mitchell LB, Knudtson ML, Ghali WA (2004). "Survival after coronary revascularization among patients with kidney disease". Circulation. 110 (14): 1890–5. doi:10.1161/01.CIR.0000143629.55725.D9. PMID 15451786. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  33. ↑ Liu JY, Birkmeyer NJ, Sanders JH, Morton JR, Henriques HF, Lahey SJ, Dow RW, Maloney C, DiScipio AW, Clough R, Leavitt BJ, O'Connor GT (2000). "Risks of morbidity and mortality in dialysis patients undergoing coronary artery bypass surgery. Northern New England Cardiovascular Disease Study Group". Circulation. 102 (24): 2973–7. PMID 11113048. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)

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