Now in Medline / Index Medicus & ISI

Discussion Forums
Meeting Highlights
Lecture Presentations
Surgical Video Library
Audio Interviews
Learning Center
For Authors
Editorial Board

21st World Congress of the World Society of Cardio-Thoracic Surgeons

The Heart Surgery Forum, Volume 7, Issue 2

Is Off-Pump Revascularization Better for Patients with Non-Dialysis-Dependent Renal Insufficiency?

Robert B. Beauford, MD,1 Craig R. Saunders, MD,1 Leo A. Niemeier, BS,1 Troy Adam Lunceford, BS,1 Ravindra Karanam, MD,1 Thomas Prendergast, MD,1 Shamji Shah, MD,1 Paul Burns, MD,2 Frederick Sardari, MD,2 Daniel J. Goldstein, MD1

Departments of Cardiothoracic Surgery, 1Newark Beth Israel Medical Center, Newark, and 2Saint Barnabas Hospital, Livingston, New Jersey, USA


Background: Renal dysfunction is a well-recognized complication following coronary artery bypass grafting (CABG). Coronary revascularization without cardiopulmonary bypass (CPB) has been shown to minimize renal injury in patients with normal preoperative renal function who undergo elective procedures. The purpose of this study was to define the effect of an off-pump revascularization strategy on the incidence of postoperative renal failure and survival of patients with preexisting renal dysfunction.

Methods: From January 1, 1999, to December 1, 2002, a total of 371 patients were identified as having a preoperative creatinine concentration greater than or equal to 1.5 mg/dL. This number included 291 patients who did not need hemodialysis or peritoneal dialysis to support renal function. These patients were subdivided into those undergoing traditional CABG with CPB (103 patients) and those undergoing off-pump revascularization (188 patients) whose demographic, operative, and outcome information was retrospectively reviewed and compared.

Results: The off-pump cohort was older than the onpump cohort (70 ± 9.6 versus 66 ± 10.9 years; P = .002), had a lower prevalence of previous myocardial infarction (35% versus 50%; P = .008), and had a modestly higher mean left ventricular ejection fraction (0.47 ± 0.01 versus 0.43 ± 0.01; P = .017). Otherwise the groups were well matched. The mean preoperative serum creatinine and creatinine clearance values were not significantly different (1.8 ± 0.5 versus 1.9 ± 0.6 mg/dL [P = .372] and 45.1 ± 15.5 versus 46.8 ± 17.2 mL/min [P = .376] for the off-pump and on-pump cohorts, respectively). There was a significant reduction in postoperative renal failure (17% versus 9% of patients; P = .020) and need for new dialysis (10% versus 3% of patients; P = .022) when CPB was eliminated. Intermediate-term survival analysis revealed a survival benefit for the off-pump group (70% versus 57%) at 42 months, although this value did not reach statistical significance (P = .143).

Conclusion: The results of this study suggested that patients with preoperative non-dialysis-dependent renal insufficiency have more favorable outcome when revascularization is done off pump. Avoidance of CPB results in (1) a reduction in the incidence of postoperative renal failure; (2) a reduction in the need for new dialysis; and (3) improved inhospital and midterm survival.

Click here for a PDF
version of the full article.

(Subscribers Only)


ISSN#: 1522-6662
Copyright 2012 Forum Multimedia Publishing, LLC. All rights reserved.

The material available at this site is for educational purposes only and is NOT intended for any diagnostic, clinically related, or other purpose. Forum Multimedia Publishing, LLC, assumes no responsibility for any use or misuse of this material and makes no warranty or representation of any kind with respect to the material available at this site.