Off-pump coronary artery bypass grafting in patients with renal dysfunction.
BACKGROUND
Renal dysfunction is a predictor of increased morbidity and mortality after coronary artery bypass grafting, whether it is dialysis-dependent or not. Several studies have shown the efficacy of off-pump technique in reducing morbidity and mortality in patients with renal dysfunction. However, the actual effect of renal dysfunction in off-pump coronary artery bypass grafting has not been well understood.


METHODS
We conducted a retrospective review of 402 consecutive patients undergoing off-pump coronary artery bypass grafting from April 2001 to June 2003. Sixty-eight patients had chronic renal dysfunction (group A); 19 patients were dialysis-dependent; 334 patients had normal renal function (group B). Operative variables, morbidity, and mortality were compared between the two groups. Furthermore, multivariable analysis was performed to identify predictors for short-term survival.


RESULTS
Preoperative characteristics were similar in the two groups. Blood transfusion rate was higher in group A than group B (57.4% and 25.7%, respectively; p < 0.001). In-hospital mortality was similar (1.5% and 1.2% in group A and B, respectively; p = 0.853). Multivariable analysis revealed that unstable angina, low ejection fraction, peripheral vascular disease and redo surgery are significant risk factors for poor early result of off-pump coronary artery bypass grafting.


CONCLUSIONS
Early outcomes of off-pump coronary artery bypass grafting in patients with renal dysfunction were comparable to those in patients with normal renal function. Renal dysfunction is not a predictor of poor early outcomes after off-pump coronary artery bypass grafting.
Tabata
Minoru
M
Department of Cardiovascular Surgery, Shin-Tokyo Hospital, Chiba, Japan. mtab-tky@umin.ac.jp
Takanashi
Shuichiro
S
Fukui
Toshihiro
T
Horai
Tetsuya
T
Uchimuro
Tomoya
T
Kitabayashi
Katsukiyo
K
Hosoda
Yasuyuki
Y
D000368:Aged; D000789:Angina, Unstable / Q000150:complications / Q000601:surgery; D002908:Chronic Disease; D047549:Coronary Artery Bypass, Off-Pump / Q000401:mortality; D003327:Coronary Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D007902:Length of Stay; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000601:surgery; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome