[HSF] Renal impairment & CABG

[Nasser F. Abou'Seada]

Dear Mitch 
Please post your references .... that will enrich our exposure a lot ....

NFA

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of Mitch Lirtzman
> Sent: Saturday, January 20, 2007 3:39 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Renal impairment & CABG
> 
> We here at Cardiovascular Institute of the South in Lafayette, La have
been
> using TRT for quite some time now with good results. My partner, David
> Allie, has the most experience and has lectured and published on the
> subject. As a matter of fact, I have one patient on it right now. If
> members would like to know more, I could post a few references on the
> Forum. We use it for patients with CRI going for heart or vascular
surgery,
> endovascular procedures, and ATN following ruptured AAA and secondary to
> rhabdomyolysis.
> Mitch Lirtzman  At 08:33 PM 1/19/2007, you wrote:
> >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
> >_______________________________________________
> >OpenHeart-L mailing list
> >
> >Send postings to:
> >  OpenHeart-L at lists.hsforum.com
> >
> >To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> >http://mmp.cjp.com/mailman/listinfo/openheart-l
> >
> >All messages transmitted by the OpenHeart-L are subject to the policies
and
> >disclaimers posted at:
> >http://www.hsforum.com/listdisclaim
> >-----------------------------------------
> 
> 
> _______________________________________________
> OpenHeart-L mailing list
> 
> Send postings to:
>  OpenHeart-L at lists.hsforum.com
> 
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
> 
> All messages transmitted by the OpenHeart-L are subject to the policies
and
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------