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Reviews in Cardiovascular Medicine (RCM) is published by IMR Press from Volume 19 Issue 1 (2018). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with MedReviews, LLC.
Open Access
Review
Contemporary Strategies to Preserve Renal Function During Cardiac and Vascular Surgery
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1
Department of Anesthesiology, The University of Texas Health Science Center, Houston, TX
2020
Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center, Houston, TX
Rev. Cardiovasc. Med. 2003, 4(S1), 21–28;
Published: 20 January 2003
Abstract
Mortality rates associated with perioperative acute renal failure (ARF) range from 60% to 90%. The major causes of ARF are prerenal factors that decrease renal blood flow; intrarenal factors that have a direct effect on tubules, interstitium, or glomeruli; and postrenal factors that obstruct urine outflow. Current strategies to provide perioperative renal protection include maintaining adequate renal O2 delivery, suppressing renovascular vasoconstriction, renovascular vasodilatation, maintaining tubular flow, decreasing renal cellular O2 consumption, and attenuating reperfusion injury. A study of patients undergoing elective repair of a thoracoabdominal aortic aneurysm (TAAA) found that the use of the selective dopamine-1 receptor agonist fenoldopam was associated with reductions in mortality, dialysis requirements, and lengths of stay in the hospital and intensive care unit. The study authors suggest that the improved patient outcomes and hospital-utilization data resulting from the use of fenoldopam were directly related to the protection of renal function during surgery and a reduction of postoperative renal complications.
Keywords
Acute renal failure
Perioperative renal protection
Cardiovascular surgery
Thoracoabdominal aortic aneurysm
Selective dopamine-1 receptor agonist
Fenoldopam