[HSF] Targeted Renal Therapy

[Ani Anyanwu]

I used targeted renal therapy for first time earlier this week. Patient was 50 year old with dilated cardiomyopathy EF ranging between 8 and 12%, severe pulmonary hypertension who underwent triple valve surgery (was not transplant candidate). His preoperative creatinine ranged from 1.9 to 2.6. His renal arteries were off-set by 5cm so was not possible to cannulate them both with single catheter so left a unilateral catheter in left renal artery and infused 0.4 mcg.kg/min of fenoldapam for 24 hours.  He was never oliguric post-operatively and his creatinine did not 'bump' as they usually do. Maybe has nothing to do with catheter - will try on some more patients before forming opinion, but I know Hal seems to be convinced it may be beneficial.

Another thing I did differently is to apply Salerno's logic and perfuse this very sick heart continuously during clamping via cannulae sutured into the coronary ostia so that the heart was never ischemic during the case (other than for very brief period when placing cannulae) . That way without ischemia there could be no ischemic injury and also no reperfusion injury and must say for a heart which barely moved before I was impressed by function coming off. No IABP even. I think this makes sense and I will do it more on sick ventricles. I have not gone all the way yet though and was not bold enough to leave the heart warm and beating - I arrested the heart and ran cold (4 degrees) blood through the case - also packed heart with slush (yes - some archaic surgeons like me still use topical cooling!).

Ani


Hgrmd at aol.com Hgrmd at aol.com <mailto:openheart-l at lists.hsforum.com?Subject=[HSF] Targeted Renal Therapy&In-Reply-To=>
Mon Jan 22 07:26:45 EST 2007 


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Dear Ahmed,
  To be honest, I found out about TRT from the rep coming by my office  last 
Wednesday.  I've read some of the brochures he left.  From what  I've seen, 
there's really nothing concrete about its efficacy, only a few case  reports.  
Apparently, intraop testing has shown that the GFR is increased  by 25% with 
the infusion.  All I know is it's fairly straight forward to  insert, and seems 
to have little downside.  Look at their website _www.flowmedica.com_ 
(http://www.flowmedica.com<http://www.flowmedica.com/>) . 
Hal