Objectives: A number of risk factors have been recognised for postoperative renal dysfunction following on-pump coronary artery bypass surgery (CABG). There are, however, few studies that have evaluated the potential reno-protective effects of off-pump CABG in the presence of other confounding risk factors. The aim of this study was to determine if off-pump CABG reduces the risk of renal injury.
Methods: Serum creatinine values (preoperatively and day 1, 2 and 4 postoperatively) and other clinical data were prospectively collected on 1580 consecutive patients who underwent first-time CABG from 2002 to 2005. Creatinine clearance was calculated using the Cockcroft and Gault equation. The effect of on-pump vs. off-pump CABG on renal function was analysed, adjusting for age, gender, diabetes mellitus, left ventricular (LV) function and preoperative creatinine clearance, using multiple regression analysis.
Results: One thousand one hundred and forty-five (73%) patients underwent on-pump CABG and 435 (27%) underwent off-pump CABG. The two groups were similar with respect to age, gender and diabetes. Two hundred and seventy-four (17%) patients were females and 274 (17%) patients had diabetes. Multivariate analysis demonstrated significantly lower creatinine clearance postoperatively in patients with diabetes (P<0.001) and advanced age (P<0.001). The on-pump group had significantly lower postoperative creatinine clearance in comparison to the off-pump group (P= 0.01). The effect remained consistent after adjusting for potential risk factors (age, diabetes, gender, LV function and preoperative creatinine clearance) in the multivariate analysis.
Conclusion: Off-pump surgery is associated with a reduction in postoperative renal injury.
ZanardoGMichielonPPaccagnellaA. Acute renal failure in the patient undergoing cardiac operation. Prevalence, mortality rate, and main risk factors. J Thorac Cardiovasc Surg1994; 107: 1489–1495.
4.
ChertowGMLevyEMHammermeisterKEGroverFDaleyJ. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med1998; 104: 343–348.
ZakeriRFreemantleNBarnettV. Relation between mild renal dysfunction and outcomes after coronary artery bypass grafting. Circulation2005; 112: I270–I275.
7.
van de WalRMvan BrusselBLVoorsAA. Mild preoperative renal dysfunction as a predictor of long-term clinical outcome after coronary bypass surgery. J Thorac Cardiovasc Surg2005; 129: 330–335.
8.
ShennibH. A renaissance in cardiovascular surgery: endovascular and device-based revascularization. Ann Thorac Surg2001; 72: S993–994.
9.
ClevelandJCJr.ShroyerALChenAYPetersonEGroverFL. Off-pump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity. Ann Thorac Surg2001; 72: 1282-1288; discussion 1288–1289.
10.
AscioneRLloydCTUnderwoodMJGomesWJAngeliniGD. On-pump versus off-pump coronary revascularization: evaluation of renal function. Ann Thorac Surg1999; 68: 493–498.
11.
BuceriusJGummertJFWaltherT. On-pump versus off-pump coronary artery bypass grafting: impact on postoperative renal failure requiring renal replacement therapy. Ann Thorac Surg2004; 77: 1250–1256.
12.
CartierR. Off-pump surgery and chronic renal insufficiency. Ann Thorac Surg2000; 69: 1995–1996.
13.
ChukwuemekaAWeiselAMagantiM. Renal dysfunction in high-risk patients after on-pump and off-pump coronary artery bypass surgery: a propensity score analysis. Ann Thorac Surg2005; 80: 2148–2153.
14.
Abu-OmarYMussaSNaikMJMacCarthyNStandingSTaggartDP. Evaluation of Cystatin C as a marker of renal injury following on-pump and off-pump coronary surgery. Eur J Cardiothorac Surg2005; 27: 893–898.
MageeMJJablonskiKAStamouSC. Elimination of cardiopulmonary bypass improves early survival for multivessel coronary artery bypass patients. Ann Thorac Surg2002; 73: 1196-1202; discussion 1202–1203.
17.
PuskasJDWilliamsWHDukePG. Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg2003; 125: 797–808.
18.
RestonJTTregearSJTurkelsonCM. Meta-analysis of short-term and mid-term outcomes following off-pump coronary artery bypass grafting. Ann Thorac Surg2003; 76: 1510–1515.
19.
TangATKnottJNansonJHsuJHawMPOhriSK. A prospective randomized study to evaluate the renoprotective action of beating heart coronary surgery in low risk patients. Eur J Cardiothorac Surg2002; 22: 118–123.
20.
Abu-OmarYTaggartDP. The present status of off-pump coronary artery bypass grafting. Eur J Cardiothorac Surg2009; 36: 312–321.
TangATAlexiouCHsuJSheppardSVHawMPOhriSK. Leukodepletion reduces renal injury in coronary revascularization: a prospective randomized study. Ann Thorac Surg2002; 74: 372-377; discussion 377.
23.
WeerasingheAAthanasiouTAl-RuzzehS. Functional renal outcome in on-pump and off-pump coronary revascularization: a propensity-based analysis. Ann Thorac Surg2005; 79: 1577–1583.
24.
KocakulakMAskinGKucukaksuSTarcanOPiskinE. Pulsatile flow improves renal function in high-risk cardiac operations. Blood Purif2005; 23: 263–267.
25.
GummertJFBuceriusJWaltherT. Requirement for renal replacement therapy in patients undergoing cardiac surgery. Thorac Cardiovasc Surg2004; 52: 70–76.
26.
Di MauroMGagliardiMIacòAL. Does off-pump coronary surgery reduce postoperative acute renal failure? The importance of preoperative renal function. Ann Thorac Surg2007 Nov; 84(5): 1496–1502.
