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Renal function after cardiac surgery off- versus on-pump coronary artery bypass: analysis using the Cockroft-Gault
George Asimakopoulos1, A Paul Karagounis, Oswaldo Valencia
1Department of Cardiothoracic Surgery, St. George's Hospital, London, United Kingdom.
Insights
Off-pump coronary artery bypass grafting (OPCAB) and on-pump coronary artery bypass grafting (on-CAB) show similar rates of renal impairment. Creatinine clearance (CrCl) did not significantly differ between the two surgical approaches, indicating comparable renal function post-procedure.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Anesthesiology
Background:
- Cardiopulmonary bypass (CPB) is frequently linked to renal dysfunction, evidenced by elevated plasma creatinine and increased hemodialysis rates.
- Renal function assessment typically involves monitoring creatinine clearance (CrCl) and plasma creatinine levels.
Purpose of the Study:
- To compare the postoperative renal function, specifically creatinine clearance (CrCl), between patients undergoing off-pump coronary artery bypass grafting (OPCAB) and on-pump coronary artery bypass grafting (on-CAB).
- To identify factors associated with new-onset renal impairment following coronary artery bypass grafting surgery.
Main Methods:
- A retrospective analysis of 704 consecutive patients undergoing either OPCAB (n=404) or on-CAB (n=300).
- Comparison of preoperative and postoperative CrCl (Cockroft and Gault formula), plasma creatinine levels, and clinical outcomes between the two surgical groups.
- Analysis of data differentiating patients with new renal impairment from those with normal postoperative renal function.
Main Results:
- No significant differences were observed in CrCl or plasma creatinine levels between OPCAB and on-CAB patients at any time point (preoperative, day 1, day 4).
- Postoperative complication rates, including stroke, hemofiltration, and mortality, were similar between the OPCAB and on-CAB groups.
- Patients with preoperative CrCl < 50 mL/min showed higher creatinine levels on day 1 in the on-CAB group; however, CrCl remained similar. New CrCl < 50 mL/min postoperatively correlated with increased need for intraaortic balloon pump, re-sternotomy, hemofiltration, and longer intensive care and hospital stays.
Conclusions:
- Both OPCAB and on-CAB procedures are associated with a low rate of renal impairment.
- No significant difference in CrCl was detected between OPCAB and on-CAB, suggesting comparable renal outcomes.
- Deterioration in renal function post-surgery is linked to a higher incidence of adverse postoperative complications, irrespective of the surgical approach.
Background:
Cardiopulmonary bypass (CPB) is often associated with renal dysfunction, as measured by plasma creatinine levels and hemodialysis rates. This study compared creatinine clearance (CrCl), estimated with the Cockroft and Gault formula, between patients undergoing off-pump coronary artery bypass grafting (OPCAB) versus on-pump CABG (on-CAB).
Methods:
Data of 704 consecutive patients were analyzed. Of these patients, 404 underwent OPCAB while 300 had on-CAB. Creatinine clearance, plasma creatinine levels, and clinical outcome were compared between groups. Data between patients who developed new renal impairment, compared to patients with normal postoperative renal function, were also analyzed.
Results:
Creatinine clearance (preoperative, 74 +/- 25 vs 78 +/- 29 mL/min; day 1, 74 +/- 26 vs 76 +/- 31 mL/min; day 4, 70 +/- 26 vs 72 +/- 29 mL/min) and creatinine levels (preoperative, 99 +/- 25 vs 95 +/- 27 micromol/L; day 1, 101 +/- 29 vs 104 +/- 35 micromol/L; day 4, 110 +/- 44 vs 113 +/- 60 micromol/L), as well as postoperative complications (stroke 1% vs 1%; hemofiltration 1.5% vs 3.7%; death 1.2% vs 2.3%), were overall similar between OPCAB and on-CAB patients. Patients with preoperative CrCl less than 50 mL/min had higher creatinine levels in the on-CAB group on day 1 (p = 0.026), although CrCl was similar between groups. Development of new CrCl less than 50 mL/min postoperatively was associated with higher rates of intraaortic balloon pump insertion, re-sternotomy, hemofiltration, intensive care and hospital stay, without difference between groups. Female sex, low body mass index, high preoperative creatinine levels, and advanced age were associated with deterioration in CrCl.
Conclusions:
Currently, the rate of renal impairment is low after both OPCAB and on-CAB. No significant difference in CrCl could be demonstrated between groups. Deterioration in renal function is associated with higher rates of postoperative complications.
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