| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
J Thorac Cardiovasc Surg 2007;133:378-388
© 2007 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease |
a Division of Cardiothoracic Surgery, CARE Hospital, The Institute of Medical Sciences, Hyderabad, India
b Division of Nephrology, CARE Hospital, The Institute of Medical Sciences, Hyderabad, India
c Division of Cardiac Anesthesiology, CARE Hospital, The Institute of Medical Sciences, Hyderabad, India
d Division of Biochemistry, CARE Hospital, The Institute of Medical Sciences, Hyderabad, India
e Division of Cardiology, CARE Hospital, The Institute of Medical Sciences, Hyderabad, India.
Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29–May 3, 2006.
Received for publication April 11, 2006; revisions received August 19, 2006; accepted for publication September 28, 2006. * Address for reprints: G. Mannam, FRCS (CT), CARE Hospitals, The Institute of Medical Sciences, Hyderabad—500034, India. (Email: gopi.mannam{at}gmail.com).
OBJECTIVE: Preoperative renal insufficiency is a predictor of acute renal failure in patients undergoing coronary artery revascularization with cardiopulmonary bypass. Off-pump coronary artery bypass grafting has been shown to be less deleterious than on-pump bypass in patients with normal renal function, but the effect of this technique in patients with non–dialysis dependent renal insufficiency in a randomized study is unknown.
METHODS: From August 2004 through October 2005, 116 consecutive patients with preoperative non–dialysis-dependent renal insufficiency (glomerular filtration rate measured using the Modification of Diet in Renal Disease equation [MDRD GFR] 
60 mL · min–1 · 1.73 m–2) undergoing primary coronary artery bypass grafting were randomized to on-pump (n = 60) and off-pump (n = 56) groups. MDRD GFR and serum creatinine levels were measured preoperatively and postoperatively at days 1 and 5. The changes in renal function and clinical outcomes were compared between the two groups.
RESULTS: Preoperative characteristics were comparable between the two groups. The repeated-measures analysis of variance was performed on the data that showed worsening of renal function in the on-pump group compared with the off-pump group (serum creatinine, P < .000; glomerular filtration rate, P < .000). Further analysis of subgroups of patients with diabetes alone, hypertension alone, and combined hypertension and diabetes also showed significant deterioration renal function in the on-pump group compared with the off-pump group. In covariate analysis, diabetes has emerged as a significant covariate by serum creatinine criteria while compromised left ventricular function has emerged as a significant covariate by glomerular filtration rate criteria. These analyses showed that the use of cardiopulmonary bypass is significantly associated with adverse renal outcome (P < .000). Three patents required hemodialysis in the on-pump group and none in the off-pump group. The mean number of grafts per patient was 3.85 ± 0.86 and 3.11 ± 0.89 in the on-pump and off-pump groups, respectively (P < .001), but the indices of completeness of revascularization, 1.00 ± 0.08 for off-pump coronary bypass and 1.01 ± 0.08 for on-pump coronary bypass, were similar (P = .60).
CONCLUSIONS: This study suggests that on-pump as compared with off-pump coronary artery bypass grafting is more deleterious to renal function in diabetic patients with non–dialysis dependent renal insufficiency. MDRD GFR is a more sensitive investigation than serum creatinine levels to assess renal insufficiency in patients undergoing coronary bypass.
Related Article
J. Thorac. Cardiovasc. Surg. 2007 133: 387-388.
This article has been cited by other articles:
|
|
 |
|
  Writing Committee Members, L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: Executive summary A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J. Thorac. Cardiovasc. Surg., January 1, 2012; 143(1): 4 - 34. [Full Text] [PDF]
|
|
|
|
 |
|
 L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, A. M. Hutter Jr, et al. Special Article: 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Anesth. Analg., January 1, 2012; 114(1): 11 - 45. [Full Text] [PDF]
|
|
|
|
 |
|
 L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, A. M. Hutter Jr, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 6, 2011; 58(24): 2584 - 2614. [Full Text] [PDF]
|
|
|
|
|
|
L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, A. M. Hutter Jr, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 6, 2011; 58(24): e123 - e210. [Full Text] [PDF]
|
|
|
|
 |
|
 Writing Committee Members, L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Circulation, December 6, 2011; 124(23): e652 - e735. [Full Text] [PDF]
|
|
|
|
|
|
Writing Committee Members, L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Circulation, December 6, 2011; 124(23): 2610 - 2642. [Full Text] [PDF]
|
|
|
|
 |
|
 L. R. Sajja, G. Mannam, R. M. Chakravarthi, J. Guttikonda, S. Sompalli, and J. Bloomstone Impact of Preoperative Renal Dysfunction on Outcomes of Off-Pump Coronary Artery Bypass Grafting Ann. Thorac. Surg., December 1, 2011; 92(6): 2161 - 2167. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Afilalo, M. Rasti, S. M. Ohayon, A. Shimony, and M. J. Eisenberg Off-pump vs. on-pump coronary artery bypass surgery: an updated meta-analysis and meta-regression of randomized trials Eur. Heart J., October 10, 2011; (2011) ehr307v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. J. Boulton, P. Kilgo, R. A. Guyton, J. D. Puskas, O. M. Lattouf, E. P. Chen, W. A. Cooper, J. D. Vega, M. E. Halkos, and V. H. Thourani Impact of Preoperative Renal Dysfunction in Patients Undergoing Off-Pump Versus On-Pump Coronary Artery Bypass Ann. Thorac. Surg., August 1, 2011; 92(2): 595 - 602. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Narayan, C. A. Rogers, K. M. Bayliss, N. C. Rahaman, N. Panayiotou, G. D. Angelini, and R. Ascione On-pump coronary surgery with and without cardioplegic arrest: comparison of inflammation, myocardial, cerebral and renal injury and early and late health outcome in a single-centre randomised controlled trial Eur J Cardiothorac Surg, May 1, 2011; 39(5): 675 - 683. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Kerendi, M. E. Halkos, J. D. Puskas, O. M. Lattouf, P. Kilgo, R. A. Guyton, and V. H. Thourani Impact of Off-Pump Coronary Artery Bypass Graft Surgery on Postoperative Pulmonary Complications in Patients With Chronic Lung Disease Ann. Thorac. Surg., January 1, 2011; 91(1): 8 - 15. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. N. Patel and G. D. Angelini Off-pump coronary artery bypass grafting: For the many or the few? J. Thorac. Cardiovasc. Surg., November 1, 2010; 140(5): 951 - 953.e1. [Full Text] [PDF]
|
|
|
|
|
|
Developed with the special contribution of the Eur, Authors/Task Force Members, W. Wijns, P. Kolh, N. Danchin, C. Di Mario, V. Falk, T. Folliguet, S. Garg, K. Huber, et al. Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Eur. Heart J., October 2, 2010; 31(20): 2501 - 2555. [Full Text] [PDF]
|
|
|
|
 |
|
 V. F. Seabra, S. Alobaidi, E. M. Balk, A. H. Poon, and B. L. Jaber Off-Pump Coronary Artery Bypass Surgery and Acute Kidney Injury: A Meta-Analysis of Randomized Controlled Trials Clin. J. Am. Soc. Nephrol., October 1, 2010; 5(10): 1734 - 1744. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The Task Force on Myocardial Revascularization of Guidelines on myocardial revascularization Eur J Cardiothorac Surg, September 1, 2010; 38(Supplement_1): S1 - S52. [Full Text] [PDF]
|
|
|
|
 |
|
 J. S. Ooi, M. R Abdul Rahman, S. A Shah, and M. Z Dimon Renal Outcome Following On- and Off-Pump Coronary Artery Bypass Graft Surgery Asian Cardiovasc Thorac Ann, December 1, 2008; 16(6): 468 - 472. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Mannam, L. R Sajja, S. B. Dandu, S. N Pathuri, K. V. Saikiran, and S. Sompalli Off-Pump Coronary Revascularization for Left Main Coronary Artery Stenosis Asian Cardiovasc Thorac Ann, December 1, 2008; 16(6): 473 - 478. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Massoudy, S. Wagner, M. Thielmann, U. Herold, E. Kottenberg-Assenmacher, G. Marggraf, A. Kribben, T. Philipp, H. Jakob, and S. Herget-Rosenthal Coronary artery bypass surgery and acute kidney injury--impact of the off-pump technique Nephrol. Dial. Transplant., September 1, 2008; 23(9): 2853 - 2860. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R. Brown, R. P. Cochran, T. A. MacKenzie, A. P. Furnary, K. S. Kunzelman, C. S. Ross, C. W. Langner, D. C. Charlesworth, B. J. Leavitt, L. J. Dacey, et al. Long-Term Survival After Cardiac Surgery is Predicted by Estimated Glomerular Filtration Rate Ann. Thorac. Surg., July 1, 2008; 86(1): 4 - 11. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O.-P. Kangasniemi, M. A. A. Mahar, E. Rasinaho, A. Satomaa, V. Tiozzo, M. Lepojarvi, and F. Biancari Impact of estimated glomerular filtration rate on the 15-year outcome after coronary artery bypass surgery Eur J Cardiothorac Surg, February 1, 2008; 33(2): 198 - 202. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. Herzog Kidney disease in cardiology Nephrol. Dial. Transplant., January 1, 2008; 23(1): 42 - 46. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
