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A Meta‐Analysis of Renal Function After Adult Cardiac Surgery With Pulsatile Perfusion
Author(s) -
Nam Myung Ji,
Lim Choon Hak,
Kim HyunJung,
Kim Yong Hwi,
Choi Hyuk,
Son Ho Sung,
Lim Hae Ja,
Sun Kyung
Publication year - 2015
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.12452
Subject(s) - pulsatile flow , medicine , cardiopulmonary bypass , perfusion , renal function , creatinine , meta analysis , cardiology , randomized controlled trial , urology , anesthesia
The aim of this meta‐analysis was to determine whether pulsatile perfusion during cardiac surgery has a lesser effect on renal dysfunction than nonpulsatile perfusion after cardiac surgery in randomized controlled trials. MEDLINE , EMBASE , and the C ochrane C entral R egister of C ontrolled T rials were used to identify available articles published before A pril 25, 2014. Meta‐analysis was conducted to determine the effects of pulsatile perfusion on postoperative renal functions, as determined by creatinine clearance ( CrCl ), serum creatinine ( Cr ), urinary neutrophil gelatinase‐associated lipocalin ( NGAL ), and the incidences of acute renal insufficiency ( ARI ) and acute renal failure ( ARF ). Nine studies involving 674 patients that received pulsatile perfusion and 698 patients that received nonpulsatile perfusion during cardiopulmonary bypass ( CPB ) were considered in the meta‐analysis. Stratified analysis was performed according to effective pulsatility or unclear pulsatility of the pulsatile perfusion method in the presence of heterogeneity. NGAL levels were not significantly different between the pulsatile and nonpulsatile groups. However, patients in the pulsatile group had a significantly higher CrCl and lower Cr levels when the analysis was restricted to studies on effective pulsatile flow ( P < 0.00001, respectively). The incidence of ARI was significantly lower in the pulsatile group ( P < 0.00001), but incidences of ARF were similar. In conclusion, the meta‐analysis suggests that the use of pulsatile flow during CPB results in better postoperative renal function.