Off-pump coronary artery bypass grafting improves in-hospital mortality in patients with dialysis-dependent renal failure.
OBJECTIVE
Patients with chronic dialysis-dependent end-stage renal disease are increasingly referred for coronary artery bypass grafting (CABG) and their early outcome is less favorable. Off-pump CABG (OPCAB) has achieved encouraging results in high-risk patients. Therefore, we designed this retrospective study to test the hypothesis that OPCAB reduced surgical risks in dialysis patients.


METHODS
From January 2000 to December 2005, 294 dialysis-dependent patients received isolated CABG at the Washington Hospital Center. Among them, 168 underwent OPCAB (off-pump group), and 126, CABG with cardiopulmonary bypass (CPB) (on-pump group). The in-hospital outcomes were analyzed.


RESULTS
The two groups were comparable in terms of preoperative characteristics. The Parsonnet's Bedside Score of the off-pump group was similar to that of the on-pump group (32.0 vs. 32.0, P=.57). The in-hospital mortality of the off-pump group was significantly lower than that of the on-pump group (5.4% vs. 11.9%, P=.04). Although the percentage of patients who received transfusions was similar, the on-pump group received more total transfusions. Logistic regression analysis revealed that use of CPB independently predicted in-hospital mortality [odds ratio (OR), 5.0; 95% confidence interval, 1.78-13.85; P<.01] and perioperative myocardial infarction (MI; OR, 5.1; 95% confidence interval, 1.18-22.40; P=.03). No significant difference in long-term survival at 4 years was absorbed between the two groups of hospital survivors.


CONCLUSIONS
Our data suggest that OPCAB is a safe alternative to on-pump CABG in dialysis patients. Avoiding CPB resulted in less perioperative blood utilization, MI, and hospital mortality.
Zhang
Li
L
Department of Surgery, Washington Hospital Center, Washington, DC 20010-2975, USA.
Boyce
Steven W
SW
Hill
Peter C
PC
Sun
Xiumei
X
Lee
Ann
A
Haile
Elizabeth
E
Garcia
Jorge M
JM
Corso
Paul J
PJ
D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000401:mortality*; D001026:Coronary Artery Bypass / Q000401:mortality*; D047549:Coronary Artery Bypass, Off-Pump / Q000401:mortality*; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016015:Logistic Models; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D016017:Odds Ratio; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome