• Benoit Bouisset, Matteo Pozzi, Martin Ruste, Thomas Varin, Marco Vola, Thomas Rodriguez, Maxime Le Jolivet, Pascal Chiari, Jean-Luc Fellahi, and Matthias Jacquet-Lagreze.
• Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron Cedex, France. Electronic address: benoit.bouisset@chu-lyon.fr.
• J. Cardiothorac. Vasc. Anesth. 2024 Oct 1; 38 (10): 221322202213-2220.

ObjectivesCardiac surgery associated-acute kidney injury is a common and serious postoperative complication of cardiac surgery, which is associated with increased postoperative morbidity and mortality. This study aimed to explore the association between cardiopulmonary bypass (CPB) blood flow rate (BFR), and major adverse kidney events (MAKEs) at day 30.DesignRetrospective single-center before-after observational study. Patients were divided in 2 groups according to CPB flow rates: a first group with an institutional protocol targeting a CPB-BFR of >2.2 L/min/m² (low CPB-BFR group), and a second group with a modified institutional protocol targeting a CPB-BFR of >2.4 L/min/m² (high CPB-BFR group). The primary outcome was MAKE at 30 days, defined as the composite of death, renal replacement therapy or persistent renal dysfunction.SettingThe data were collected from clinical routines in university hospital.ParticipantsAdult patients who underwent elective and urgent cardiac surgery without severe chronic renal failure, for whom CPB duration was ≥90 minutes.InterventionsWe included 533 patients (low CPB-BFR group, n = 270; high CPB-BFR group, n = 263).Measurements And Main ResultsA significant decrease in MAKE at 30 days was observed in the high CPB-BFR group (3% v 8%; odds ratio [OR], 0.779; 95% confidence interval [CI], 0.661-0.919; p < 0.001) mainly mediated by a lower 30-day mortality in the high CPB-BFR group (1% v 5%; OR, 0.697; 95% CI, 0.595-0.817; p = 0.001), as was renal replacement therapy (1% v 4%; OR, 0.739; 95% CI, 0.604-0.904; p = 0.016).ConclusionsIn patients undergoing cardiac surgery, increased CPB-BFR was associated with a decrease in MAKE at 30 days including mortality and renal replacement therapy.Copyright © 2024 Elsevier Inc. All rights reserved.

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