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Does off-pump coronary artery bypass grafting beneficially affect renal function?
Mitsugu Ogawa1, Hitoshi Yaku, Kiyoshi Doi
1Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. m-ogawa@koto.kpu-m.ac.jp
Insights
Off-pump coronary artery bypass grafting (CABG) shows better renal protection compared to on-pump CABG. However, patients with left ventricular dysfunction or undergoing multivessel grafting require close renal monitoring even with off-pump procedures.
Area of Science:
- Cardiology
- Nephrology
- Surgical Innovation
Background:
- Off-pump coronary artery bypass grafting (CABG) is suggested to improve renal function, but evidence requires further confirmation.
- Assessing the impact of off-pump CABG on renal function is crucial for surgical decision-making.
Purpose of the Study:
- To evaluate the effects of off-pump CABG on renal function.
- To identify predictors of postoperative renal impairment in patients undergoing off-pump CABG.
Main Methods:
- Retrospective study of 451 patients undergoing isolated CABG (1999-2003).
- Comparison of perioperative serum creatinine levels and creatinine ratios between off-pump (n=300) and on-pump (n=151) CABG groups.
- Logistic regression analysis to identify predictors of renal impairment.
Main Results:
- Renal impairment occurred in 12.7% of the off-pump group versus 18.5% of the on-pump group (P=0.1).
- The creatinine ratio was significantly lower in the off-pump group (1.2 ± 0.4) compared to the on-pump group (1.4 ± 0.7, P=0.003).
- Strongest predictors for renal impairment in off-pump CABG were left ventricular dysfunction (OR 10.8) and multivessel grafting (OR 4.3).
Conclusions:
- Off-pump CABG offers superior renal protection compared to on-pump CABG.
- Close perioperative renal monitoring is essential for patients with left ventricular dysfunction or those undergoing multivessel grafting, even with off-pump CABG.
Background:
Off-pump coronary artery bypass grafting (CABG) has been reported to beneficially affect renal function, but this remains to be confirmed. The purpose of the present paper was to study the effects of off-pump CABG on renal function and analyse predictors of postoperative renal impairment in patients who received off-pump CABG.
Methods:
A total of 451 patients who underwent isolated CABG between January 1999 and August 2003 were retrospectively studied. No patient was receiving dialysis. A total of 300 patients (228 men) underwent off-pump CABG (off-pump group) and 151 patients (104 men) underwent on-pump CABG (on-pump group). Perioperative serum creatinine levels and creatinine ratios (peak postoperative creatinine level/preoperative creatinine level) were compared between the groups.
Results:
Renal impairment (serum creatinine >1.5 mg/dL) developed postoperatively in 12.7% of the off-pump group and 18.5% of the on-pump group (P = 0.1). The creatinine ratio was significantly lower in the off-pump group (1.2 +/- 0.4) than in the on-pump group (1.4 +/- 0.7, P = 0.003). Logistic regression analysis demonstrated that the strongest predictors of postoperative renal impairment in off-pump CABG were left ventricular dysfunction (odds ratio 10.8) and multivessel grafting (odds ratio 4.3).
Conclusions:
Off-pump CABG provides better renal protection than on-pump CABG. However, perioperative renal function should be closely monitored in patients who have left ventricular dysfunction or who undergo multivessel grafting, even when off-pump CABG is performed.
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