Complex Coronary Bypass Surgery In patients of Renal Failure & poor Heart Function with Uncontrolled Diabetes Mallitus.
- drpavankumar
- 0
- on Jul 29, 2017
Mr.K. 70 yrs old had long standing uncontrolled diabetes. Due to that he first developed diabetic nephropathy & renal insufficiency & two silent myocardial infarctions. Due to these infarctions heart pumping capacity was reduced to 30%. Renal parameters showed raised Sr. Creatinine of 2.4 requiring large doses of diuretics.
This patient was admitted in intensive care due to recent episode of Left ventricular failure. He underwent aggressive anti-failure treatment with NIV. After optimal medical stabilisation by diuretics, inotropes, & diabetes control. He underwent coronary angiography which showed severe Triple vessel disease involving left main stem 70%, LAD – 100%, RCA-100%, OM2-90%, D2-100% occlusion. He was advised coronary artery bypass surgery ( CABG).
This CABG was complex & highly risky due to multiple organ dysfunction like deranged kidney function, poor heart pumping,poor Lung functions & continuous insulin infusion. In this case it is very important to have critical management by cardiac anaesthesia so as to not have hypotension & adverse drug reactions, intraoperative fluid & electrolyte management & hemodynamic management while coronary revascularisation is being done. Here due to left main CAD It was pre-decided to do this case on cardiopulmonary bypass & using hemodialyzer to support kidney function & electrolyte management. Use of Swan-Ganz catheter helps in hemodynamic , inotrope & fluid management. Continuous diuretic infusion & insulin infusion was also done. Patient received four vessel coronary artery bypass graft utilising left IMA & saphenous veins in a short 50 mts CPB & blood cardioplegic myocardial protection. There was smooth wean off from CPB with out any problems. Minimum inotrope support was required for stable hemodynamics & patient was transferred to ICU in good condition . He was safely weaned off ventilator next day & discharged on 7th post operation day.
Optimal medical management in these complex multiorgan dysfunctions is important to make patient fit to undergo CABG safely. Understanding multiorgan dysfunction & use of current support system for preservation of kidney, Lung, & heart during operation precludes any inotropes, IABP , wound infection, renal shutdown like morbidities & provides successful outcome.
I have developed special protocol for these renal failure patients to undergo safe CABG & results have been rewarding.
Dr. Pavan Kumar (M.S,M.Ch.,F.I.A.C.S.)
Consultant Cardiovascular & Thoracic Surgeon
9820297125 / 9820160600