Our Summary

This research paper reviews the effectiveness of different strategies aimed at protecting the kidneys from damage following a common type of heart surgery (cardiopulmonary bypass or CPB). Kidney damage, known as acute kidney injury (AKI), is a common complication of this surgery and sometimes requires further treatment called renal replacement therapy (RRT), which can increase the risk of illness and death.

The researchers looked at 88 scientific articles and identified 26 different methods of trying to protect the kidneys after CPB. They paid particular attention to three strategies: a drug called N-acetylcysteine (NAC), a technique called remote ischaemic preconditioning (RIPC), and the use of certain anesthetic agents (VAAs).

Unfortunately, their analysis found that none of these approaches significantly reduced the risk of kidney injury or the need for RRT after heart surgery. Therefore, they concluded that there is still uncertainty about the best way to protect the kidneys during this type of surgery. Future research could look at combining different strategies or focusing on patients who are particularly at risk of kidney damage.

FAQs

  1. What strategies did the researchers investigate for protecting the kidneys during cardiopulmonary bypass surgery?
  2. Did the study find any methods that significantly reduced the risk of kidney damage or the need for renal replacement therapy following heart surgery?
  3. What possibilities does the research suggest for future studies to protect the kidneys during heart surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about heart bypass surgery is to closely follow post-operative care instructions, including taking prescribed medications, attending follow-up appointments, and making necessary lifestyle changes such as adopting a heart-healthy diet and engaging in regular exercise. By following these recommendations, patients can help improve their overall recovery and reduce the risk of complications, including kidney damage.

Suitable For

Patients who are typically recommended heart bypass surgery are those with severe coronary artery disease, which is a condition in which the blood vessels that supply blood to the heart become narrowed or blocked. This can lead to chest pain (angina), shortness of breath, and an increased risk of heart attack.

Specific criteria for recommending heart bypass surgery may include:

  • Severe blockages in multiple coronary arteries
  • Left main coronary artery disease
  • Severe blockages in the proximal (beginning) of a major coronary artery
  • Severe symptoms that are not relieved by medication or other treatments
  • High risk of a heart attack or other complications

Patients with these criteria are more likely to benefit from heart bypass surgery, as it can improve blood flow to the heart muscle, reduce symptoms, and lower the risk of a heart attack. It is important for patients to discuss their individual situation with their healthcare provider to determine if heart bypass surgery is the best treatment option for them.

Timeline

Before heart bypass surgery:

  1. Consultation with a cardiologist to determine the need for surgery
  2. Pre-operative tests and evaluations to assess overall health and heart function
  3. Discussion with the surgeon about the risks and benefits of the procedure
  4. Preparing for surgery by following any pre-operative instructions given by the medical team
  5. Admission to the hospital on the day of surgery

After heart bypass surgery:

  1. Recovery in the intensive care unit (ICU) immediately after surgery
  2. Monitoring of vital signs and oxygen levels
  3. Pain management and medication to prevent infection
  4. Gradual progression to walking and physical therapy
  5. Discharge from the hospital once stable, usually within a week
  6. Follow-up appointments with the surgeon and cardiologist to monitor recovery and provide further guidance on lifestyle changes

Overall, the patient may experience a period of recovery and rehabilitation after heart bypass surgery, with the goal of improving heart function and overall health.

What to Ask Your Doctor

  1. What is the likelihood of developing acute kidney injury (AKI) following heart bypass surgery?

  2. What are the potential risks and complications associated with AKI and the need for renal replacement therapy (RRT) after heart bypass surgery?

  3. Are there any specific factors or medical conditions that may increase my risk of developing kidney damage following heart bypass surgery?

  4. What steps can be taken during the surgery to minimize the risk of kidney injury?

  5. Are there any pre-existing medications or medical conditions that may impact my risk of kidney damage during or after heart bypass surgery?

  6. What is the role of N-acetylcysteine (NAC), remote ischaemic preconditioning (RIPC), and certain anesthetic agents (VAAs) in protecting the kidneys during heart bypass surgery?

  7. Have any recent studies or clinical trials shown promising results in preventing kidney injury during heart bypass surgery?

  8. What are the potential long-term effects of kidney damage following heart bypass surgery?

  9. How often will my kidney function be monitored after the surgery, and what are the signs or symptoms of kidney injury that I should watch out for?

  10. Are there any lifestyle changes or dietary recommendations that can help protect my kidneys after heart bypass surgery?

Reference

Authors: Tan SI, Brewster DJ, Horrigan D, Sarode V. Journal: ANZ J Surg. 2019 Apr;89(4):296-302. doi: 10.1111/ans.14800. Epub 2018 Sep 21. PMID: 30239089