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Coronary artery bypass grafting for patients with non-dialysis-dependent renal dysfunction (serum creatinine > or
H Hirose1, A Amano, A Takahashi
1Department of Cardiovascular Surgery, Kobari General Hospital, 29-1 Yokouchi, Noda City, 278-8501, Chiba, Japan. genex@nifty.com
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Patients with renal dysfunction undergoing coronary artery bypass grafting (CABG) face higher operative risks and poorer long-term outcomes. Off-pump CABG may offer a faster recovery for these high-risk cardiac surgery patients.
Area of Science:
- Cardiology
- Nephrology
- Cardiac Surgery
Background:
- Renal dysfunction is a known risk factor for coronary atherosclerosis.
- Patients with chronic kidney disease often present with cardiovascular complications.
Purpose of the Study:
- To evaluate the outcomes of coronary artery bypass grafting (CABG) in patients with impaired renal function.
- To compare the results of off-pump versus on-pump CABG in patients with serum creatinine ≥ 2.0 mg/dl.
Main Methods:
- Retrospective analysis of isolated CABG patients from May 1991 to April 2000.
- Comparison of non-dialysis-dependent patients with serum creatinine ≥ 2.0 mg/dl (Group R, n=59) against controls (serum creatinine < 2.0 mg/dl, Group C, n=1666).
Main Results:
- Group R had longer operative times and more frequent major complications (28.8% vs 10.7%) and mortality (6.8% vs 0.5%).
- Off-pump CABG showed faster recovery than on-pump CABG in Group R.
- 3-year survival (75.3% vs 96.9%) and cardiac event-free rates (76.7% vs 87.3%) were significantly lower in Group R.
Conclusions:
- Decreased renal function significantly increases operative risks and prolongs hospital care after CABG.
- Long-term survival and cardiac event-free rates are inferior in patients with renal dysfunction compared to those with normal renal function, even after successful revascularization.
Introduction:
Patients with renal dysfunction carry a risk of coronary atherosclerosis. The purpose of this study was to evaluate the outcome after coronary artery bypass grafting (CABG) in patients with decreased renal function (serum creatinine > or =2.0 mg/dl).
Methods:
We retrospectively analyzed consecutive patients who had undergone isolated CABG at Shin-Tokyo Hospital between May 1, 1991 and April 31, 2000. Preoperative, perioperative, and follow-up data of the non-dialysis-dependent patients with preoperative serum creatinine equal to or more than 2.0mg/dl (group R, n=59) were collected, and compared with those of the control patients (serum creatinine < 2.0, group C, n=1666). Group R was further divided into the off-pump and on-pump CABG group and their perioperative results were compared.
Results:
Group R included 51 males and eight females with a mean age of 66.4. The mean number of anastomoses was not significantly different between groups; however, clump time and pump time were longer in group R. Postoperative recovery was longer in group R than in group C, which is associated with a more frequent occurrence of major complications (28.8% in group R and 10.7% in group C, P<0.0001) and mortalities (6.8% in group R and 0.5% in group C, P<0.0005). The patients who underwent off-pump CABG experienced relatively faster recovery than those who underwent on-pump CABG, despite decreased renal function. At the mean follow-up of 2.4 years, the actuarial 3-year survival rate of groups R and C were 75.3 and 96.9%, respectively (P<0.0001), excluding hospital mortality. The actuarial 3-year cardiac event-free rate was 76.7% in group R and 87.3% in group C (P<0.05).
Conclusions:
Patients with decreased renal function carry significant operative risks and require prolonged hospital care. Even after adequate surgical revascularization was completed, the long-term cardiac event-free and survival rates in the patients with renal dysfunction were inferior to the patients with normal renal function.