title: Clinical outcome of patients with and without renal impairment undergoing a minimally invasive LIMA-to-LAD bypass operation.
abstract: OBJECTIVE
  Patients with renal impairment undergoing conventional coronary artery bypass grafting (CABG) have a significant risk of postoperative deterioration of kidney function. We investigated the outcome of patients with and without renal impairment treated by off-pump coronary artery surgery.
  
  
  METHODS
  From January 1997 until January 2000, 158 consecutive patients (mean age 63 +/- 9.8 years, 126 male, 32 female) underwent minimally LIMA-to-LAD bypass operations. The patients were divided into three groups: group I patients (n = 133) had a preoperative creatinine of < 1.3 mg/dL, group II patients (n = 21) had a creatinine of > 1.3 mg/dL, and patients of group III (n = 4) required chronic dialysis due to terminal kidney dysfunction. Monitoring of the blood creatinine was performed during the entire hospital stay. A postoperative angiogram was performed in 113 of the 158 patients.
  
  
  RESULTS
  All operations were performed without intraoperative complications. Postoperative angiograms revealed a patent LIMA-to-LAD bypass in all but one patient, who demonstrated a dissection of the left internal mammary artery (LIMA) graft. Mean creatinine value on admission was 1.0 +/- 0.1 mg/dL in group I and 2.7 +/- 1.9 mg/dL in group II. The maximal postoperative creatinine value was 1.1 +/- 0.4 mg/dL in group I and 2.9 +/- 2.7 mg/dL in group II. Neither hemofiltration nor hemodialysis was necessary in any patient of group I or group II during the postoperative course.
  
  
  CONCLUSIONS
  Minimally invasive LIMA-to-LAD bypass is a safe and effective procedure with low morbidity and no mortality in the first 158 patients. Preoperative renal impairment had no adverse effect on outcome or residual kidney function. Thus, higher doses of diuretics and hemofiltration/dialysis were not used, resulting in a cost reduction. Therefore, this approach may be worthwhile to consider in patients with significant renal impairment who have to undergo CABG.
authors.affiliation: Heart Center Hamburg, Albertinen-Hospital and Center for Cardiology, Hamburg, Germany. riessf@aol.com
authors.forename: F C
authors.initials: FC
authors.lastname: Riess
authors.forename: S
authors.initials: S
authors.lastname: Moshar
authors.forename: R
authors.initials: R
authors.lastname: Bader
authors.forename: J
authors.initials: J
authors.lastname: Schofer
authors.forename: C
authors.initials: C
authors.lastname: Löwer
authors.forename: P
authors.initials: P
authors.lastname: Kremer
authors.forename: N
authors.initials: N
authors.lastname: Bleese
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging; D006085:Graft Survival; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000379:methods*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D012016:Reference Values; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D018570:Risk Assessment; D016896:Treatment Outcome; D014654:Vascular Patency