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Published on: September 15, 2023
Renal function after off-pump versus on-pump coronary artery bypass grafting
Rana Sandip Singh1, Shyam Kumar Singh Thingnam1, Anand Kumar Mishra1
11 Department of Cardiothoracic and Vascular Surgery, 29751 Postgraduate Institute of Medical Education and Research , Chandigarh, India.
Insights
Off-pump coronary artery bypass surgery does not significantly protect against kidney dysfunction compared to on-pump surgery in low-risk patients. Both methods showed similar impacts on renal function markers post-operation.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Anesthesiology
Background:
- Renal dysfunction is a significant complication following coronary artery bypass grafting (CABG).
- Off-pump CABG (OPCAB) is theoretically associated with reduced renal impact.
- Assessing renal function markers is crucial for evaluating surgical techniques.
Purpose of the Study:
- To compare renal function between on-pump and off-pump CABG.
- To evaluate creatinine clearance as a marker of renal dysfunction post-CABG.
- To determine if OPCAB offers renal protection compared to conventional CABG.
Main Methods:
- Thirty patients undergoing CABG were randomized into on-pump (n=15) and off-pump (n=15) groups.
- Preoperative and postoperative serum creatinine and creatinine clearance were measured for 4 days.
- Demographic characteristics were similar between the two groups.
Main Results:
- No significant difference in serum creatinine rise between on-pump and off-pump groups on postoperative days 1 and 4.
- No significant difference in the fall of creatinine clearance between the groups on postoperative days 1 and 4.
- Postoperative renal function markers were comparable between the two surgical techniques.
Conclusions:
- Coronary artery bypass surgery technique (on-pump vs. off-pump) does not significantly affect renal function.
- Off-pump CABG does not provide significant protection against postoperative renal dysfunction in low-risk patients.
- Both surgical approaches demonstrate similar outcomes regarding renal function post-CABG.
Abstract:
Background Renal dysfunction is a well-recognized major complication after coronary artery bypass grafting. Off-pump coronary artery bypass theoretically appears to have less impact on renal function. We estimated preoperative and postoperative creatinine clearance as a marker of renal dysfunction in patients undergoing off-pump and on-pump coronary artery bypass. Methods Thirty patients undergoing coronary artery bypass were randomly allocated to undergo either on-pump ( n = 15) or off-pump surgery ( n = 15). The two groups had similar preoperative demographic characteristics. Serum creatinine and creatinine clearance were measured for 4 days postoperatively and the results were compared with preoperative levels. Results The rise in serum creatinine on postoperative day 1 was 0.28 mgċdL-1 in the on-pump group and 0.22 mgċdL-1 in the off-pump group ( p = 0.27); on postoperative day 4 it was 0.15 mgċdL-1 and 0.10 mgċdL-1, respectively, ( p = 0.28). Similarly, the fall in creatinine clearance was 17.34 mLċmin-1 in the on-pump group and 19.62 mLċmin-1 in the off-pump group on postoperative day 1 ( p = 0.42), and 10.9 and 10.94 mLċmin-1, respectively, on postoperative day 4 ( p = 0.64). Conclusion Renal function is not affected by the technique of coronary artery bypass surgery, whether with or without cardiopulmonary bypass, in spite of the theoretical advantage of off-pump surgery. Our study suggests that off-pump coronary artery bypass surgery does not confer significant protection from postoperative renal dysfunction in low-risk patients, when compared with on-pump surgery.
