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Published on: March 26, 2018
Renal Outcome in Patients Undergoing Minimally Invasive Total Coronary Revascularization via Anterior Minithoracotomy
Christian Sellin1, Sarah Laube2, Volodymyr Demianenko1
1Department of Cardiothoracic Surgery, Klinikum Fulda gAG, University Medicine Marburg, Campus Fulda, 36043 Fulda, Germany.
Insights
Minimally invasive total coronary revascularization via anterior minithoracotomy (TCRAT) shows comparable renal outcomes to traditional coronary artery bypass grafting (CABG). This sternum-sparing approach offers shorter hospital stays without increasing kidney complications.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Minimally Invasive Procedures
Background:
- Renal dysfunction and acute renal failure are significant complications following coronary artery bypass grafting (CABG), increasing mortality and morbidity.
- Minimally invasive total coronary revascularization via anterior minithoracotomy (TCRAT) is a sternum-sparing technique with promising outcomes, but its impact on renal complications requires further investigation.
Purpose of the Study:
- To compare renal outcomes between TCRAT and conventional CABG via full median sternotomy (FS).
- To evaluate the incidence of postoperative renal complications, including acute renal failure and the need for hemodialysis, in patients undergoing TCRAT versus FS.
Main Methods:
- A retrospective analysis of 227 TCRAT patients and 228 FS patients undergoing non-emergent CABG.
- Propensity score matching was used to ensure comparable baseline characteristics between the TCRAT (n=170) and FS (n=170) groups.
- Postoperative renal parameters (serum creatinine, eGFR, serum urea), acute renal failure (ARF), hemodialysis, operative times, and length of stay were analyzed.
Main Results:
- While TCRAT involved longer operative duration, cardiopulmonary bypass (CPB) time, and aortic cross-clamp time, there were no significant differences in postoperative renal parameters or complications between the TCRAT and FS groups.
- Intensive care unit (ICU) and hospital stays were significantly shorter in the TCRAT group compared to the FS group.
- No increase in renal complications or need for hemodialysis was observed in the TCRAT group despite longer procedural times.
Conclusions:
- The TCRAT technique for coronary artery bypass grafting does not lead to an increase in renal complications compared to conventional full median sternotomy.
- Despite longer operative times, TCRAT offers the benefit of reduced ICU and hospital stays.
- TCRAT is a safe and effective alternative for patients with multivessel coronary artery disease, with favorable renal and length-of-stay outcomes.
Abstract:
Objective: Renal dysfunction and acute renal failure after coronary artery bypass grafting (CABG) are among the main causes of increased mortality and morbidity. A sternum-sparing concept of minimally invasive total coronary revascularization via anterior minithoracotomy (TCRAT) was introduced with promising early and midterm outcomes in multivessel coronary artery disease. There are limited data regarding renal complications in patients undergoing the TCRAT technique. The present study analyzed renal outcomes in TCRAT compared to CABG via full median sternotomy (FS). Methods: We analyzed the records of 227 consecutive TCRAT patients (from September 2021 to June 2023) and 228 consecutive FS patients (from January 2017 to December 2018) who underwent nonemergent CABG. Following propensity score matching, preoperative baseline characteristics-including age, sex, diabetes mellitus, arterial hypertension, left ventricular ejection fraction, EuroSCORE II, preoperative serum creatinine, estimated glomerular filtration rate (eGFR), serum urea, and pre-existing chronic renal insufficiency-were comparable between the TCRAT (n = 170) and the FS group (n = 170). The examined postoperative renal parameters and complications were serum creatinine, eGFR, and serum urea on the first postoperative day. Moreover, serum creatinine, eGFR and serum urea at the time of discharge, postoperative ARF, and hemodialysis were investigated. Additionally, the duration of operation, CPB time, aortic cross-clamp time, ICU and hospital stay, ECMO support, rethoracotomy and in-hospital mortality were analyzed. The parameters were compared between groups using a Student's t-test or Mann-Whitney U test. Results: The duration of operation (332 ± 66 vs. 257 ± 61 min; p < 0.05), CPB time (161 ± 40 vs. 116 ± 38 min; p < 0.05), and aortic cross-clamp time (100 ± 31 vs. 76 ± 26; p < 0.05) were longer in the TCRAT group. ICU (1.8 ± 2.2 vs. 2.9 ± 3.6 days; p < 0.05) and hospital (10.4 ± 7.6 vs. 12.4 ± 7.5 days; p < 0.05) stays were shorter in the TCRAT group. There were no differences between groups with regard to the renal parameters examined. Conclusions: Despite a prolonged duration of operation, CPB time, and aortic cross-clamp time when using the TCRAT technique, no increase in renal complications were found. In addition, ICU and hospital stays in the TCRAT group were shorter compared to CABG via full median sternotomy.
