Off-pump versus on-pump coronary artery bypass procedures:postoperative renal complications in an Asian population.
BACKGROUND
Diabetes and habitual smoking cause advanced coronary artery disease (CAD) in Asian patients at a younger age. No definite data exist as to whether off-pump (OPCAB) is better than conventional on-pump coronary artery bypass grafting (CCAB) in terms of postoperative renal complications. Thus, we aimed to compare the renal outcomes of on-pump and off-pump coronary artery bypass grafting (CABG) on our patients, which constituted a predominantly Asian population.


METHODS
A cohort of 395 patients following CCAB were compared with 293 patients who underwent OPCAB. Baseline demographics, comorbidities, intraoperative data, intensive care unit stay, number of grafts, New York Heart Association (NYHA) score, American Society of Anesthesiologists (ASA) score, EuroSCORE risk assessment model, and postoperative complications particularly renal, were collected and analysed.


RESULTS
The off-pump group consisted of significantly older patients with higher Canadian Cardiovascular Society (CCS) and ASA scores. Additionally, the off-pump group involved a significantly greater number of smokers and chronic obstructive pulmonary disease (COPD) patients. Other demographic parameters were not different between the groups. Postoperative investigations showed a significantly elevated serum creatinine (100.3 +/- 42.5 vs 127.6 +/- 114.2 micromol/L; off-pump vs on-pump; P = 0.039) and urea levels (5.9 +/- 3.1 vs 10.6 +/- 15.6 mg/dL; off-pump vs on-pump; P = 0.006) in the on-pump group. Moreover, there was a high tendency towards a higher rate of renal dysfunction associated death in this group.


CONCLUSIONS
OPCAB is a safe and equally efficient operative method compared to CCAB, and has a significant lower risk for postoperative renal complications as a treatment modality for surgical coronary revascularisation.
Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore.
Sivakkanan
S
Loganathan
Chih Chiang
CC
Nieh
Maximilian Y
MY
Emmert
Felix
F
Woitek
Eliana C
EC
Martinez
Sonja
S
Muecke
Chuen Neng
CN
Lee
Theo
T
Kofidis
D000328:Adult; D000368:Aged; D001208:Asia / Q000208:ethnology; D015331:Cohort Studies; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D003422:Critical Care; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011183:Postoperative Complications; D051437:Renal Insufficiency / Q000209:etiology*; D012846:Singapore