Impact of a large hemodialysis arteriovenous fistula: On myocardial protection during cardiopulmonary bypass

Cetin L., ŞENER E., Kunt A., HIDIROĞLU M., Kucuker A.

Texas Heart Institute Journal, vol.39, no.1, pp.122-124, 2012 (SCI-Expanded, Scopus) identifier identifier

  • Publication Type: Article / Article
  • Volume: 39 Issue: 1
  • Publication Date: 2012
  • Journal Name: Texas Heart Institute Journal
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.122-124
  • Keywords: Arteriovenous fistula, Bicaval cannulation, Cardioplegia, Cardiopulmonary bypass, Coronary artery bypass, Dialysis, Kidney failure, Myocardial protection, Renal dialysis
  • Ankara Yıldırım Beyazıt University Affiliated: Yes

Abstract

Arteriovenous fistulae have a substantial impact on systemic hemodynamics, but their effect on cardiopulmonary bypass is not well understood. The left-to-right shunting of blood through an arteriovenous fistula can create flow problems during cardiopulmonary bypass. We present the case of a 59-year-old man with end-stage renal disease who underwent coronary artery bypass grafting. During surgery, a large brachiocephalic arteriovenous fistula provided excessive venous return to the heart, compromising the myocardial protection offered by cardiopulmonary bypass. We modified the venous cannulation from a 2-stage single cannula to a bicaval cannula and were then able to achieve cardioplegic arrest and myocardial protection with no further problems. © 2012 by the Texas Heart® Institute, Houston.