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Effect of one-stop hybrid coronary revascularization on postoperative renal function and bleeding: a comparison study
Shan Zhou1, Zhongrong Fang1, Hui Xiong2
1Department of Anesthesiology, State Key Laboratory of Translational Cardiovascular Medicine, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China.
Insights
One-stop hybrid coronary revascularization shows reduced bleeding and transfusion needs compared to off-pump CABG. This approach does not significantly increase acute kidney injury risk in patients with multivessel coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- One-stop hybrid coronary revascularization combines surgical and percutaneous approaches for multivessel coronary artery disease.
- Potential risks include contrast dye and antiplatelet drug exposure, leading to acute kidney injury and coagulopathy.
Purpose of the Study:
- To compare renal function, postoperative bleeding, and transfusion requirements between hybrid revascularization and off-pump coronary artery bypass grafting (CABG).
Main Methods:
- Retrospective analysis of 141 patients undergoing one-stop hybrid coronary revascularization.
- Propensity score matching with 141 off-pump CABG patients.
- Comparison of renal function changes, chest tube drainage, and clinical outcomes.
Main Results:
- Hybrid revascularization patients had significantly less chest tube drainage and fewer blood transfusions.
- The hybrid group showed a trend towards higher acute kidney injury incidence, but not statistically significant.
- Hybrid revascularization required less inotropic support, had fewer respiratory complications, and shorter ICU stays.
Conclusions:
- One-stop hybrid coronary revascularization offers benefits of reduced postoperative bleeding and transfusion needs.
- This approach does not significantly increase the risk of acute kidney injury compared to off-pump CABG.
Objectives:
Although 1-stop hybrid coronary revascularization offers potential benefits for selected patients with multivessel coronary artery disease, the exposure to contrast dye and potent antiplatelet drugs could increase the risk of postoperative acute kidney injury and coagulopathy. The goal of the present study was to compare the measures of renal function, postoperative bleeding, and transfusion requirements in patients undergoing hybrid revascularization compared with off-pump coronary artery bypass grafting (CABG).
Methods:
We retrospectively analyzed the data from 141 consecutive patients who had undergone 1-stop hybrid coronary revascularization from June 2007 to January 2011. Propensity score matching with 141 off-pump CABG patients from our surgical database was performed for comparison. The change in renal function, cumulative chest tube drainage, and clinical outcome parameters were compared between the 2 groups.
Results:
Compared with off-pump CABG, patients undergoing hybrid revascularization had significantly less chest tube drainage at 12 hours after surgery (P = .04) and for the total amount during the postoperative period (P < .001) and required fewer blood transfusions (P = .001). The hybrid group had a higher incidence of acute kidney injury, but this did not reach statistical significance (25.2% vs 17.6%, P = .13). The hybrid group required less inotropic and vasoactive support, had fewer respiratory complications, required a shorter time of mechanical support, and had a decreased length of intensive care unit stay.
Conclusions:
Compared with off-pump CABG, 1-stop hybrid coronary revascularization was associated with benefits such as less postoperative bleeding and blood transfusion requirements without significantly increasing the additional risk of acute kidney injury.
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