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CARDIOVASCULAR ANESTHESIA

Does Off-Pump Coronary Artery Bypass Reduce the Incidence of Clinically Evident Renal Dysfunction After Multivessel Myocardial Revascularization?

Departments of Anesthesiology, and Cardiovascular Medicine and Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania

Address correspondence and reprint requests to Nanette Schwann, MD, Department of Anesthesiology, MS 310, Drexel University College of Medicine, 245 N. 15th St., Philadelphia, PA 19102. Address e-mail to schwann{at}drexel.edu

In this prospective, observational trial, we determined whether off-pump coronary artery bypass (OPCAB) was associated with less postoperative renal dysfunction (RD) compared with coronary bypass surgery with cardiopulmonary bypass (CABG). All patients undergoing primary, isolated coronary surgery at our institution in the year 2000 participated. Data collected on each patient included demographics, preoperative risk factors for RD, perioperative events, and serum creatinine concentrations from date of admission until discharge or death. The criteria for RD was both a 50% increase from preoperative creatinine and an absolute postoperative creatinine 2.0 mg/dL (177 µM). Student’s t-test or the Fisher’s exact test was used to compare groups. Stepwise multiple logistic regression identified determinants of RD; P < 0.05 significant. The CABG group (n = 119) differed from the OPCAB group (n = 220) with respect to age (64 ± 13 versus 67 ± 10 yr, P = 0.0074) and number of distal grafts (median 4 versus 3, P = 0.0003). Type of operation did not associate with the presence of postoperative RD: 18 (8.2%) of 220 OPCAB patients versus 12 (10%) of 119 CABG patients (P = 0.55). Our data suggest that choice of operative technique (OPCAB versus CABG) is not associated with reduced renal morbidity.

IMPLICATIONS: This prospective, observational trial suggests that patients who undergo complete coronary revascularization without cardiopulmonary bypass (off-pump) have similar incidences of postoperative creatinine increases when compared with patients undergoing traditional coronary artery bypass surgery with cardiopulmonary bypass.

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