Effects of cardiopulmonary bypass on dialysis-dependent patients

Area of Science:

• Cardiovascular Surgery
• Nephrology
• Critical Care Medicine

Background:

• End-stage renal disease (ESRD) is an independent risk factor for survival after coronary artery bypass grafting (CABG).
• Patients with ESRD undergoing CABG require careful consideration of surgical techniques to optimize outcomes.

Purpose of the Study:

• To compare peri-operative morbidity and mortality rates between on-pump (ONCAB) and off-pump (OPCAB) coronary artery bypass grafting in dialysis-dependent renal insufficiency patients.
• To evaluate short-term postoperative outcomes for ESRD patients undergoing different CABG strategies.

Main Methods:

• Retrospective analysis of 110 dialysis-dependent renal insufficiency patients who underwent CABG between 2010 and 2017.
• Group 1: Patients operated with cardiopulmonary bypass (ONCAB).
• Group 2: Patients operated with off-pump coronary artery bypass surgery (OPCAB).

Main Results:

• ONCAB group (74 patients) showed statistically significant higher requirements for blood transfusion, drainage, intra-aortic balloon pump use, and intensive care unit stay compared to OPCAB group (36 patients) (p < 0.05).
• Postoperative creatine kinase (CK) and creatine kinase-muscle/brain (CKMB) levels were significantly higher in the ONCAB group (p = 0.003).
• These findings suggest increased peri-operative complications associated with ONCAB in ESRD patients.

Conclusions:

• On-pump coronary artery bypass grafting (ONCAB) presents a potential risk for morbidity and mortality in end-stage renal disease patients.
• Off-pump coronary artery bypass surgery (OPCAB) may lead to improved postoperative outcomes.
• OPCAB should be considered a viable surgical option for ESRD patients requiring coronary artery bypass grafting.