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J Thorac Cardiovasc Surg 2006;131:1261-1266
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

On-pump versus off-pump coronary surgery outcomes in patients requiring dialysis: Perspectives from a single center and the United States experience

Divisions of Cardiology and Nephrology, Department of Internal Medicine, Department of Surgery, Hennepin County Medical Center, United States Renal Data System–Cardiovascular Special Studies Center, Minneapolis Medical Research Foundation, University of Minnesota–Twin Cities, Minneapolis, Minn.

Received for publication August 23, 2005; revisions received December 28, 2005; accepted for publication December 30, 2005.

^_* Address for reprints: Joseph Van Camp, MD, Department of Surgery, Hennepin County Medical Center, 701 Park Ave, Minneapolis, MN 55415. (Email: joe.van.camp{at}co.hennepin.mn.us).

OBJECTIVE: Coronary artery bypass graft surgery carries increased risk for patients requiring dialysis compared with other groups. Little data exist comparing outcomes of on-pump and off-pump techniques in dialysis patients. This study compares outcomes of bypass grafting in dialysis patients with these two techniques at a single institution and in the United States Renal Data System (USRDS) database.

METHODS: From March 1997 to April 2004, 37 patients requiring dialysis underwent bypass graft surgery at our institution. On-pump surgery was performed for 16 patients and off-pump surgery for 21. From January 1, 2001, to December 31, 2002, a total of 3922 patients in the USRDS underwent bypass graft surgery. On-pump surgery was performed for 3382 and off-pump surgery for 540. Comparisons were made between patients undergoing on-pump and off-pump bypass surgery with respect to demographics, risk factors, and outcomes. Univariate analysis, the Kaplan-Meier method, and a multivariate Cox model were used.

RESULTS: Institutional analysis revealed similar patient demographics, risk factors, use of thoracic artery grafts, and number of distal anastomoses. Outcome analysis was significant for less postoperative atrial fibrillation with the off-pump technique: 37.5% on-pump and 4.8% off-pump (P = .028). USRDS data revealed all-cause survivals at 1 and 18 months of 87.5% and 59.5% for on-pump versus 88.3% and 61.9% for off-pump procedures (P = .226). In a comorbidity-adjusted Cox model, off-pump bypass grafting was associated with a 16% reduction in all-cause mortality (P = .032).

CONCLUSION: Off-pump bypass grafting is uncommon in patients in the United States who require dialysis. Off- pump bypass grafting provides a morbidity benefit and is associated with a lower risk of death.

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