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Off-pump versus on-pump coronary artery bypass surgery and postoperative renal dysfunction
M G Gamoso1, B Phillips-Bute, K P Landolfo
1Cardiothoracic Division, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Anesthesia and Analgesia
|October 26, 2000
Summary
Off-pump coronary artery bypass grafting (OPCAB) did not show a significant reduction in postoperative renal dysfunction compared to conventional coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). This study suggests renal risk alone should not guide the choice between OPCAB and CABG.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Perioperative Medicine
Background:
- Renal dysfunction is a significant complication following coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB).
- The duration of CPB is linked to renal outcomes, prompting investigation into off-pump coronary artery bypass (OPCAB) as a potential method to mitigate renal injury.
Purpose of the Study:
- To test the hypothesis that OPCAB surgery is associated with less postoperative renal dysfunction compared to CABG surgery.
Main Methods:
- A retrospective analysis of 690 primary elective coronary bypass patients (55 OPCAB, 635 CABG).
- Perioperative change in creatinine clearance (DCrCl) was calculated using preoperative and peak postoperative serum creatinine values via the Cockroft-Gault equation.
- Univariate and linear multivariate tests were employed, with P < 0.05 considered significant.
Main Results:
- Multivariate analysis did not identify OPCAB surgery as an independent predictor of DCrCl.
- Preoperative creatinine clearance, age, and diabetes were confirmed as significant predictors of DCrCl.
- The study had 80% power to detect a 7.0 mL/min DCrCl difference between groups.
Conclusions:
- This retrospective study could not confirm that OPCAB significantly reduces perioperative renal dysfunction compared to CABG.
- Findings suggest that reducing renal risk should not be the sole indication for choosing OPCAB over CABG.