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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.
The Annals of Thoracic Surgery
|September 4, 1999
Summary
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.