Reply to Lema and Canessa Free

Thank you for your interest in my paper and your comments [1].

Our results confirm that preoperative ClCr value is able to influence the short-term outcome instead the CPB time, the clamp-time and the type of cardiac surgery procedure. We think that with the new technology, such as coated circuit, miniaturized circuit, it is possible to minimize the early and late complications of cardiac surgery [2].

We propose that is not the time of CPB or clamp-time that is able to influence the short-term outcome in cardiac surgery, but the type of cardiac protection during surgery, the haematocrit level and the body temperature during the procedure. There are many factors that can influence the postoperative course, but the CPB time is not one of them. We suggest that an early identification of mild and moderate renal dysfunction helps clinicians to provide surgical care.

Lema et al. [3] sustain that the ‘pre-bypass and post-operative period is the most vulnerable time affecting renal haemodynamic, rather than CPB’ but this is another end point not related with our study. The aim of this study was to investigate the impact of mild and moderate renal dysfunction on short-term outcome in open-heart surgery.

The effect of CPB on renal function and the high number of factors that could affect it (the anaesthesia, the bypass technique used, the presence of mannitol in the perfusate, pulsatile non-pulsatile blood flow) is still unclear and controversial [4].

References