[HSF] Renal impairment & CABG

[A]

Hal:
I am intrigued by you renal failure prophylaxis, how does it work?
As you might expect we get more than our fair share of reops and some of
them have borderline renal function. Please enlighten me about TRT (targeted
renal therapy).Thank you

Ahmed


  ----- Original Message ----- 
  From: Hgrmd at aol.com<mailto:Hgrmd at aol.com> 
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> 
  Sent: Friday, January 19, 2007 9:33 PM
  Subject: Re: [HSF] Renal impairment & CABG


  Ed,
    I tried something new today.  This 60 yo diabetic man presented  with
CHF 
  and angina.  Cath revealed patent LIMA to LAD, patent vein graft  to OM.
EF 
  45% with severe MR and mod-severe TR by TEE.  Baseline  creatinine 1.4.
Patient 
  had 6 vessel CABG 4 years ago.  Duplex  scanning revealed one segment of 
  vein.  Both radials weren't usable.   The RIMA was patent.  All would
agree that 
  this isn't a great case, and  that there would be a propensity for ATN and

  other problems.
    After induction, the endovascular surgeon in my group and the rep
helped 
  me insert a bifurcated transfemoral catheter that infused fenoldapam in
both 
  renal arteries throughout the case.  It's called TRT (targeted renal
therapy). 
   It seemed to work OK, though I did notice that the systemic  pressure was
a 
  little soft, presumably from the systemic effects of this  vasodilator.
    I cannulated femorally and went on CPB just prior to splitting the  
  sternum.  Thank God I did, because the RV was plastered to the sternum,
and  I made a 
  2.5 cm rent in the anterior wall of the RV.  Since I was on CPB,  it
wasn't a 
  big deal to free up the heart and close the rent without  tension.  I did
a 
  vein graft to the RCA with a 6 cm extraction  endarterectomy.  I repaired
the 
  mitral and tricuspid valves.  The  patient seems to be doing OK thus far,
and 
  the kidneys are working  well. 
    Perhaps this TRT will help decrease postop ATN.  Does  anybody else have

  experience with this?  The rep told me that "Dr.  Ani" from Mt Sinai was 
  starting to use it.  
   
  Hal 
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