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Published on: February 2, 2021
On-pump versus off-pump coronary artery bypass grafting: impact on postoperative renal failure requiring renal
Jan Bucerius1, Jan F Gummert, Thomas Walther
1Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany. bucerj@medizin.uni-leipzig.de
Insights
Postoperative renal failure is common after coronary artery bypass grafting (CABG). Off-pump CABG surgery significantly reduces the risk of requiring renal replacement therapy compared to traditional CABG.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Critical Care Medicine
Background:
- Postoperative renal failure remains a significant complication following coronary artery bypass grafting (CABG).
- This complication is associated with adverse patient outcomes despite advancements in perioperative care.
Purpose of the Study:
- To evaluate risk factors for postoperative renal failure requiring renal replacement therapy after myocardial revascularization.
- To compare the incidence of postoperative renal replacement therapy between coronary artery bypass grafting (CABG) with and without cardiopulmonary bypass (off-pump CABG).
Main Methods:
- Prospective data from 9,631 patients undergoing myocardial revascularization were analyzed.
- Univariate and multivariate logistic regression analyses were used to identify predictors of postoperative renal replacement therapy.
- Patients received either standard CABG or off-pump CABG.
Main Results:
- The overall prevalence of postoperative continuous renal replacement therapy was 4.1% (4.3% for CABG, 1.8% for off-pump CABG; p=0.001).
- Fifteen independent predictors for renal replacement therapy were identified in the overall population.
- Off-pump CABG demonstrated a significantly lower predictive value for postoperative renal replacement therapy.
Conclusions:
- Preoperative renal insufficiency increases the risk of requiring postoperative renal replacement therapy after CABG.
- Off-pump CABG is associated with a reduced prevalence of postoperative renal replacement therapy compared to standard CABG.
Background:
Despite refinements in perioperative patient management postoperative renal failure requiring hemofiltration or dialysis is still a common complication after coronary artery bypass grafting associated with impaired patient outcome.
Methods:
Prospective data on 9,631 patients receiving myocardial revascularization with (coronary artery bypass grafting [n = 8,870]) or without cardiopulmonary bypass (off-pump coronary artery bypass grafting [n = 761]) between April 1996 and August 2001 were evaluated by univariate and multivariate logistic regression analysis.
Results:
Overall prevalence of postoperative continuous renal replacement therapy was 4.1% (coronary artery bypass grafting, 4.3%; off-pump coronary artery bypass grafting, 1.8%; p = 0.001). Thirty of 40 selected preoperative and intraoperative patient and treatment related variables had a high association with the requirement for postoperative renal replacement therapy; fifteen of these variables were independent predictors in the whole study population. Off-pump coronary artery bypass surgery was identified as having a significantly lower predictive value for postoperative continuous renal placement therapy. In the subgroup of patients undergoing off-pump coronary artery bypass grafting surgery, a second multivariate logistic regression model revealed preoperative cardiogenic shock, urgent operation, intraoperative low cardiac output, and high transfusion requirement as independent predictors for postoperative renal replacement therapy.
Conclusions:
Patients with preoperative nondialysis dependent renal insufficiency are at a high risk for further decline in renal function requiring postoperative continuous renal replacement therapy. Off-pump coronary artery bypass surgery is associated with a lower prevalence of postoperative renal replacement therapy after coronary artery bypass grafting.
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