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Primary coronary artery bypass surgery in the presence of decreasing preoperative renal function: effect on
Hasanga Jayasekera1, Ryan Harvey, Nigel Pinto
1Department of Cardiothoracic Surgery, Princess Alexandra Hospital, Brisbane, Australia.
Insights
Coronary artery bypass grafting (CABG) in patients with declining kidney function significantly increases risks for complications and death. Renal failure substantially elevates short-term mortality following CABG surgery.
Area of Science:
- Cardiology
- Nephrology
- Surgical Outcomes
Background:
- Assessing the impact of reduced kidney function on outcomes after coronary artery bypass grafting (CABG).
- Evaluating short-term results in patients undergoing primary CABG with varying degrees of renal impairment.
Purpose of the Study:
- To determine the association between decreasing renal function and short-term outcomes in patients undergoing primary coronary artery bypass grafting (CABG).
Main Methods:
- Prospective data collection from February 1999 to February 2009 on 4050 primary CABG patients, analyzed retrospectively.
- Patients categorized into three groups based on preoperative serum creatinine: normal (<2 mg/dL), renal failure (>2 mg/dL), and dialysis.
- Comparison of short-term outcomes across the three renal function groups.
Main Results:
- Significant differences observed in blood product use, postoperative myocardial infarction, pulmonary complications, infection, and mortality rates across groups (CABG:D > CABG:RF > CABG:N).
- Patients on dialysis (CABG:D) faced a 25-fold higher risk of 30-day mortality compared to those with normal renal function (CABG:N).
Conclusions:
- Coronary artery bypass grafting (CABG) in patients with renal failure is linked to considerably higher morbidity and mortality.
- Preoperative renal function is a critical factor influencing short-term outcomes after CABG.
Background:
This study evaluated the impact of decreasing renal function on short-term outcomes in patients undergoing primary coronary artery bypass grafting (CABG).
Methods:
The study period was from February 1999 to February 2009. Data on 4050 patients undergoing primary CABG were prospectively collected and analyzed retrospectively. The study population was divided into 3 groups: the CABG:N group, patients with preoperative serum creatinine levels <2 mg/dL (n = 3947); the CABG:RF group, patients with preoperative creatinine levels >2 mg/dL (n = 87); and the CABG:D group, patients on dialysis (n = 16).
Results:
The significant differences between the groups (CABG:D > CABG:RF > CABG:N) in short-term outcomes were with respect to blood product use (P < .001), postoperative acute myocardial infarction (P < .001), pulmonary complications (P .001), infection (P < .001), and death (P < .001). The risk of short-term death (30 days) in the CABG:D group (4/16, 25%) was 25 times greater than that in the CABG:N group (38/3947, 0.96%).
Conclusion:
CABG in the presence of renal failure is associated with significant morbidity and mortality.
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