Is off-pump revascularization better for patients with non-dialysis-dependent renal insufficiency?

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

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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 on-pump 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 in-hospital and midterm survival.

Original languageEnglish (US)
Pages (from-to)84-89
Number of pages6
JournalHeart Surgery Forum
Volume7
Issue number2
StatePublished - 2004
Externally publishedYes

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Renal Insufficiency
Cardiopulmonary Bypass
Kidney
Creatinine
Coronary Artery Bypass
Survival
Dialysis
Incidence
Peritoneal Dialysis
Survival Analysis
Stroke Volume
Renal Dialysis
Myocardial Infarction
Demography
Wounds and Injuries
Serum

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Beauford, R. B., Saunders, C. R., Niemeier, L. A., Lunceford, T. A., Karanam, R., Prendergast, T., ... Goldstein, D. J. (2004). Is off-pump revascularization better for patients with non-dialysis-dependent renal insufficiency? Heart Surgery Forum, 7(2), 84-89.

Is off-pump revascularization better for patients with non-dialysis-dependent renal insufficiency? / Beauford, Robert B.; Saunders, Craig R.; Niemeier, Leo A.; Lunceford, Troy Adam; Karanam, Ravindra; Prendergast, Thomas; Shah, Shamji; Burns, Paul; Sardari, Frederick; Goldstein, Daniel J.

In: Heart Surgery Forum, Vol. 7, No. 2, 2004, p. 84-89.

Research output: Contribution to journalArticle

Beauford, RB, Saunders, CR, Niemeier, LA, Lunceford, TA, Karanam, R, Prendergast, T, Shah, S, Burns, P, Sardari, F & Goldstein, DJ 2004, 'Is off-pump revascularization better for patients with non-dialysis-dependent renal insufficiency?', Heart Surgery Forum, vol. 7, no. 2, pp. 84-89.
Beauford RB, Saunders CR, Niemeier LA, Lunceford TA, Karanam R, Prendergast T et al. Is off-pump revascularization better for patients with non-dialysis-dependent renal insufficiency? Heart Surgery Forum. 2004;7(2):84-89.
Beauford, Robert B. ; Saunders, Craig R. ; Niemeier, Leo A. ; Lunceford, Troy Adam ; Karanam, Ravindra ; Prendergast, Thomas ; Shah, Shamji ; Burns, Paul ; Sardari, Frederick ; Goldstein, Daniel J. / Is off-pump revascularization better for patients with non-dialysis-dependent renal insufficiency?. In: Heart Surgery Forum. 2004 ; Vol. 7, No. 2. pp. 84-89.
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abstract = "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 on-pump 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 in-hospital and midterm survival.",
author = "Beauford, {Robert B.} and Saunders, {Craig R.} and Niemeier, {Leo A.} and Lunceford, {Troy Adam} and Ravindra Karanam and Thomas Prendergast and Shamji Shah and Paul Burns and Frederick Sardari and Goldstein, {Daniel J.}",
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T1 - Is off-pump revascularization better for patients with non-dialysis-dependent renal insufficiency?

AU - Beauford, Robert B.

AU - Saunders, Craig R.

AU - Niemeier, Leo A.

AU - Lunceford, Troy Adam

AU - Karanam, Ravindra

AU - Prendergast, Thomas

AU - Shah, Shamji

AU - Burns, Paul

AU - Sardari, Frederick

AU - Goldstein, Daniel J.

PY - 2004

Y1 - 2004

N2 - 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 on-pump 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 in-hospital and midterm survival.

AB - 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 on-pump 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 in-hospital and midterm survival.

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