{"id":85,"date":"2017-07-29T16:07:43","date_gmt":"2017-07-29T10:37:43","guid":{"rendered":"http:\/\/drpavankumar.in\/blog\/?p=85"},"modified":"2025-06-18T19:23:39","modified_gmt":"2025-06-18T13:53:39","slug":"complex-coronary-bypass-surgery-in-patients-of-renal-failure-poor-heart-function-with-uncontrolled-diabetes-mallitus","status":"publish","type":"post","link":"https:\/\/drpavankumar.in\/blog\/complex-coronary-bypass-surgery-in-patients-of-renal-failure-poor-heart-function-with-uncontrolled-diabetes-mallitus\/","title":{"rendered":"Complex Coronary Bypass Surgery In patients of Renal Failure & poor Heart Function with Uncontrolled Diabetes Mallitus."},"content":{"rendered":"

\"Best<\/p>\n

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.<\/p>\n

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 \u2013 100%, RCA-100%, OM2-90%, D2-100% occlusion. He was advised coronary artery bypass surgery ( CABG).<\/p>\n

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.<\/p>\n

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.<\/p>\n

I have developed special protocol for these renal failure patients to undergo safe CABG & results have been rewarding.<\/p>\n

Dr. Pavan Kumar (M.S,M.Ch.,F.I.A.C.S.)
\nConsultant Cardiovascular & Thoracic Surgeon
\n9820297125 \/ 9820160600<\/p>\n","protected":false},"excerpt":{"rendered":"

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 […]<\/p>\n","protected":false},"author":1,"featured_media":198,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-85","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-angioplasty"],"yoast_head":"\nPrimary Cardiac Tumor Surgeon in Mumbai | Myxoma Specialist in Mumbai<\/title>\n<meta name=\"description\" content=\"Seeking an expert Coronary Bypass Surgeon in Mumbai? Dr Pavan Kumar specializes in complex cases, offering advanced techniques for optimal outcomes. 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