title: Symmetry aortic connector devices and acute renal injury: a comparison of renal dysfunction after three different aortocoronary bypass surgery techniques.
abstract: Although the pathogenesis of acute renal injury after cardiac surgery is multifactorial, atherosclerosis of the ascending aorta and embolic burden are strong independent predictors. Use of the Symmetry aortic connector device (ACD) for proximal anastomosis of coronary grafts may reduce ascending aortic atheroembolism. Therefore, we tested the hypothesis that off-pump coronary artery bypass (OPCAB) surgery performed using an ACD is associated with less postoperative renal dysfunction compared with conventional OPCAB or on-pump coronary artery bypass graft (CABG) surgery. Three-thousand-three-hundred consecutive patients undergoing non-emergent aortocoronary bypass surgery were retrospectively divided into three groups by surgical procedure; Group A: OPCAB with ACD (n = 124), Group B: standard OPCAB (n = 313), Group C: on-pump CABG (n = 2863). Postoperative peak fractional change in creatinine compared with baseline was used as a measure of renal outcome. Multivariable analysis did not identify ACD use as an independent predictor of postoperative peak fractional change in creatinine (P = 0.71), although the relationships of several known renal risk factors with postoperative peak fractional change in creatinine were confirmed. We could not find evidence that OPCAB surgery using ACDs reduces acute renal injury compared with standard OPCAB or CABG surgery.
authors.affiliation: Cardiothoracic Division, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Stephanie S F
authors.initials: SS
authors.lastname: Fischer
authors.forename: Barbara
authors.initials: B
authors.lastname: Phillips-Bute
authors.forename: Madhav
authors.initials: M
authors.lastname: Swaminathan
authors.forename: Carmelo
authors.initials: C
authors.lastname: Milano
authors.forename: Mark
authors.initials: M
authors.lastname: Stafford-Smith
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000517:prevention & control; D000368:Aged; D001011:Aorta / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013525:Surgical Instruments