Background The hypothesis that fenoldopam mesylate, by increasing renal flow, could reduce renal damage in patients undergoing cardiac surgery with cardiopulmonary bypass has gained great interest. ...The aim of the current study was to quantify the relationship of the increase of the renal blood flow as a function of the fenoldopam dose in these patients and to evaluate renal flow distribution within the renal parenchyma using Doppler. Methods Twenty-five patients admitted to cardiac surgery have been enrolled. We used the Doppler technique to measure renal blood flow at the level of the renal, segmental, interlobar, and interlobular arteries. We calculated both the resistive and pulsatility indexes in all the renal segments. Moreover, we calculated echographically all the variables of preload, afterload, and cardiac index. Measurements were performed at baseline and after the infusion of fenoldopam mesylate at the doses of 0.05, 0.1, 0.2, and 0.3 μg · kg−1 · min−1. Results Fenoldopam infusion at doses more than 0.1 μg · kg−1 · min−1 significantly increases blood flow in all renal compartments, thus improving the resistive and pulsatility indexes starting at a dose of 0.1 μg · kg−1 · min−1 . The highest renal flow increase is observed with 0.3 μg · kg−1 · min−1 . Fenoldopam seems to increase the renal flow directed to the most external kidney areas. Systemic hemodynamically significant changes are observed only in patients receiving doses more than 0.1 μg · kg−1 · min−1. Conclusions In hemodynamically stable patients undergoing cardiac surgery with preserved renal function, fenoldopam shows a pharmacodynamic dose-dependent profile: it significantly increases renal flow and reduces the resistances of the renal circulation starting at a dose of 0.1 μg · kg−1 · min−1.
Advanced heart failure (HF) represents a public health priority due to the increase of affected patients and the meaningful mortality. Durable mechanical circulatory support (MCS) and heart ...transplantation (HTx) are unique therapies for end-stage HF (ESHF), with positive early and long-term outcomes. The patients who underwent HTx have a 1-y survival of 91% and a median survival of 12-13 y, whereas the median survival of ESHF is <12 mo. Short-term MCS with veno-arterial extracorporeal membrane oxygenation (VA ECMO) can be used as a bridge to transplantation strategy. Patients bridged with VA ECMO have significantly lower survival in comparison with non-MCS bridged and left ventricular assist device-bridged patients. VA ECMO represents an effective, and sometimes unique, system to obtain rapid hemodynamic stabilization, but possible negative effects on patients' outcomes after HTx must be considered. Here, we discuss the use of VA ECMO as bridge to transplantation.
Objective The purpose of this study was to evaluate the effect of 0.1 μg/kg/min of fenoldopam mesylate on renal flow and central hemodynamics measured by echocardiography in hemodynamically stable ...patients with preserved renal function undergoing cardiac surgery. Design Experimental observational study. Setting Single-institutional community hospital study. Participants Thirty patients undergoing cardiac surgery. Intervention Fenoldopam mesylate infusion (0.1 μg/kg/min) in patients undergoing cardiopulmonary bypass. Measurements and Main Results Doppler measurements of renal blood flow and echocardiographic hemodynamic determinations after Doppler echocardiography measured flux velocities of the main, segmental, and interlobar and interlobular right renal arteries. The authors calculated the resistive index of all the renal segments studied. Moreover, the authors measured the flux of the main renal artery and its diameter as well as the main hemodynamic variables. All the measurements were performed in the intensive care unit setting at baseline and 20 minutes after the infusion of 0.1 μg/kg/min of fenoldopam mesylate. Fenoldopam mesylate infusion significantly increased blood flow in all renal compartments, thus improving the resistive index. The study showed that fenoldopam mesylate infusion does not induce any significant change of the heart rate or arterial pressure, cardiac output, preload, or wall stress. Conclusions In hemodynamically stable cardiac surgery patients with preserved renal function, an infusion of 0.1 μg/kg/min of fenoldopam mesylate has no influence on systemic hemodynamics while increasing renal blood flow.
Objectives To measure the effects of fenoldopam mesylate infusion on splanchnic blood flow in patients undergoing myocardial revascularization with cardiopulmonary bypass. Design An experimental ...observational study. Setting A single-institution community hospital. Participants Eighteen patients undergoing on-pump coronary artery bypass graft surgery. Interventions Fenoldopam mesylate infusion (0.1 μg/kg/min). Measurements and Main Results Blood flow through the celiac artery, superior mesenteric artery, portal vein and hepatic artery were assessed by means of Doppler measurements. The main hemodynamic variables were measured using echocardiography. The infusion of fenoldopam significantly increased the blood flow through both celiac and superior mesenteric arteries by decreasing vascular resistance. The percentage of cardiac output directed to these 2 vessels increased significantly; the increase through the superior mesenteric artery was greater compared with the celiac artery. Portal vein and hepatic artery blood flow also consistently increased. No significant variations were observed with respect to hemodynamic variables. Conclusions The infusion of fenoldopam increased the flow through the celiac artery and superior mesenteric artery; the effect was higher for the latter. These changes did not affect the hemodynamic variables.
Background Global population aging and greater age-related incidence of ischemic, degenerative and calcific valve disease have led to an increasing number of very elderly patients being referred for ...valve surgery. However, their preoperative risk factors, and in-hospital and long-term outcomes have not been thoroughly investigated. Methods Three hundred seven consecutive patients 80 years and older (60% female; mean age 83 ± 2.4 years) attending three major Italian cardiac centres to undergo valve surgery were evaluated. Seventy-nine patients underwent mitral valve surgery (isolated n = 30, combined n = 49) and 228 underwent aortic valve surgery (isolated n = 134, combined n = 94). Results The most frequent in-hospital complications were atrial arrhythmias, need for inotropic support for more than 48 h, renal insufficiency, congestive heart failure, respiratory failure, and stroke or transient ischemic attack. The in-hospital mortality rate was 9.7% (30 of 307). Multivariate logistic regression identified the following clinical variables as predictors of in-hospital death: New York Heart Association functional class IV, diabetes, hypertension, renal insufficiency at presentation, rheumatic etiology and left ventricular ejection fraction of less than 45%. Late mortality occurred in 45 of 277 patients (16.2%), but there was a substantial improvement in the New York Heart Association functional class of the 232 long-term survivors (from 3.0±0.7 to 1.7±0.6; P<0.0001). Conclusions Surgery seems to be an effective therapeutic option for selected symptomatic octogenarians with valve disease, associated with good long-term survival and an improved functional class. Operative mortality is related more to patients’ preoperative clinical status and increased comorbidity than the type of surgery per se.
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