Hippokratia 2006; 10(2): 75-79

M Toumbouras, D Grekas, C Voucharas, P Spanos
Dpt Cardiac Surgery, Renal Unit and 1st Medical Department University Hospital AHEPA, Thessaloniki, Greece

Abstract

Renal dysfunction is known to be a major predictor of in-hospital and remote mortality among patients with coronary artery disease (CAD), who undergo coronary artery bypass grafting (CABG). The aim of this study was to investigate the outcome of patients with non-dialysis-dependent renal dysfunction, who underwent on - pump and off-pump CABG.
Methods. Between October 1, 1996 and September 30, 2000, a total of 1723 consecutive patients underwent isolated CABG. Fifty-nine of 1723 patients with CAD had also renal dysfunction (serum creatinine ?2 mg/dl). On-pump CABG was performed in 43/59 and off-pump CABG in 16/59 patients. The causes of renal dysfunction were diabetes mellitus (49.2%), hypertension (18.6%), atherosclerosis(13.6%), chronic glomerulonephritis (8,5%) and others(10.1%) of unknown etiology. In on-pump CABG we maintained the perfusion pressure above 60 mmHg. Furocemide or mannitol were given during the heart surgery. Off-pump CABG was performed using initially a compression type of coronary stabilizer and after mid-1999 a suction type of stabilizer.
Results. The hospital mortality rate was 3 / 43 (7.0%) in on -pump and 1 / 16 (6.3%) in off-pump group. The Intensive Care Unit (ICU) stay was significantly shorter in off-pump group than the on-pump group (p < 0.05), and the length of postoperative stay was two-thirds of that in the on-pump group. No significant differences were found in terms of the long-term survival of cardiac event-free rate between the two groups. Postoperative hemodialysis was performed in 8 / 59 patients.
Conclusions. Patients with renal dysfunction carry significant operative risks and require prolonged hospital care. Off-pump CABG strategy in these patients is safe and contributes to the improvement of both postoperative and remote results. The long-term results were not different between the two groups in this study.

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Keywords: renal dysfunction, on-pump, off-pump coronary artery bypass grafting (CABG), preoperative risk factors, surgical results, postoperative results, survival

Correspoding author: Grekas DM, Renal Unit, University Hospital AHEPA, Thessaloniki, Greece