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Testing the Efficacy of Pharmacological Agents in a Pericardial Target Delivery Model in the Swine
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A prospective randomized study to evaluate the renoprotective action of beating heart coronary surgery in low risk

A T M Tang1, J Knott, J Nanson

  • 1Department of Cardiac Surgery, Wessex Regional Cardiac & Thoracic Unit, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK. gus.tang@ntlworld.com

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|July 10, 2002
PubMed

Insights

Off-pump coronary artery bypass surgery (OPCAB) does not protect kidneys more than on-pump coronary artery bypass (ONCAB). Both procedures show similar, mild renal injury in low-risk patients, indicating no significant renoprotective advantage for OPCAB.

Area of Science:

  • Cardiology
  • Nephrology
  • Surgical Innovation

Background:

  • Cardiopulmonary bypass (CPB) is linked to renal failure after coronary artery bypass grafting (CABG).
  • Off-pump coronary surgery (OPCAB) is anecdotally considered renoprotective compared to on-pump coronary artery bypass (ONCAB).

Purpose of the Study:

  • To compare the extent of renal glomerular and tubular injury between OPCAB and ONCAB in low-risk patients.
  • To determine if OPCAB offers renoprotection over ONCAB during coronary artery surgery.

Main Methods:

  • Prospective randomization of 40 low-risk patients into OPCAB (n=20) and ONCAB (n=20) groups.
  • Measurement of urinary microalbumin and retinol binding protein (RBP) indexed to creatinine (Cr) as indicators of glomerular and tubular injury.
  • Monitoring of fluid balance, serum creatinine, and blood urea levels postoperatively.

Main Results:

  • No mortality or overt renal complications were observed in either group.
  • Both OPCAB and ONCAB groups showed similar, significant increases in urinary RBP:Cr and microalbumin:Cr, indicating renal tubular and glomerular injury.
  • Serum creatinine and blood urea remained within normal limits throughout the study for all patients.

Conclusions:

  • Sensitive biomarkers reveal comparable renal tubular and glomerular injury following both OPCAB and ONCAB.
  • Avoidance of CPB does not provide additional renoprotection for low-risk patients undergoing CABG.
  • The study suggests that for low-risk individuals, the choice between OPCAB and ONCAB may not significantly impact perioperative renal insult.
Abstract

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