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On-pump versus off-pump coronary revascularization: evaluation of renal function
R Ascione1, C T Lloyd, M J Underwood
1Bristol Heart Institute, Bristol Royal Infirmary, United Kingdom.
Insights
Off-pump coronary artery bypass grafting (CABG) surgery significantly protects kidney function compared to on-pump CABG. This beating heart technique reduces renal compromise, offering a safer alternative for patients undergoing revascularization.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Anesthesiology
Background:
- Coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB) carries a risk of renal dysfunction.
- Off-pump CABG (OPCAB) is being re-evaluated for potential benefits in preserving organ function.
Purpose of the Study:
- To investigate whether beating heart revascularization (off-pump CABG) prevents renal compromise compared to conventional on-pump CABG.
Main Methods:
- A prospective, randomized controlled trial involving 50 patients undergoing elective CABG.
- Patients were assigned to either on-pump CABG or off-pump CABG.
- Renal function (glomerular and tubular) was assessed up to 48 hours postoperatively.
Main Results:
- No deaths, myocardial infarctions, or acute renal failure occurred in either group.
- On-pump CABG showed significantly worse glomerular filtration (creatinine clearance, microalbumin/creatinine ratio) (p < 0.0004, p < 0.0083).
- On-pump CABG also resulted in impaired renal tubular function (N-acetyl glucosaminidase activity) (p < 0.0272).
Conclusions:
- Off-pump coronary revascularization provides superior renal protection compared to conventional on-pump CABG with cardioplegic arrest.
- Beating heart surgery is a favorable option for first-time coronary bypass patients to preserve renal function.
Background:
Coronary revascularization with cardiopulmonary bypass has the potential risk of renal dysfunction related to the nonphysiologic nature of cardiopulmonary bypass. Recently, there has been a revival of interest in performing myocardial revascularization on the beating heart and we investigated whether this prevents renal compromise.
Methods:
A prospective, randomized, controlled trial was performed in 50 patients (45 males, mean age 61+/-3.7 years) undergoing elective coronary artery bypass grafting. Patients were randomly assigned to conventional revascularization with cardiopulmonary bypass (on pump) or beating heart revascularization (off pump). Glomerular and tubular function were assessed up to 48 hours postoperatively.
Results:
There were no deaths, myocardial infarctions or acute renal failure in either group. Glomerular filtration as assessed by creatinine clearance and the urinary microalbumin/creatinine ratio was significantly worse in the on pump group (p < 0.0004 and 0.0083, respectively). Renal tubular function was also impaired in the on pump group as assessed by increased N-acetyl glucosaminidase activity (p < 0.0272).
Conclusions:
These results suggest that off pump coronary revascularization offers a superior renal protection when compared with conventional coronary revascularization with cardiopulmonary bypass and cardioplegic arrest in first time coronary bypass patients.