Coronary artery bypass grafting with or without cardiopulmonary bypass in patients with preoperative non–dialysis dependent renal insufficiency: A randomized study

Abstract

This study suggests that on-pump as compared with off-pump coronary artery bypass grafting is more deleterious to renal function in diabetic patients with non-dialysis dependent renal insufficiency. MDRD GFR is a more sensitive investigation than serum creatinine levels to assess renal insufficiency in patients undergoing coronary bypass.

Current Evidence of On-Pump Versus Off-Pump Coronary Artery By-Pass Surgery

“…Five years postoperatively 130/142 OPCAB-patients and 130/139 CCABG patients were alive (p=ns). Other studies with up to twelve months follow-up also failed to show any difference (7)(8)(9)(10)(11)(12)(13). Due to the relatively low risk of mortality associated with either operation, however, the statistical strength to detect any difference is not present in any of these studies.…”

“…Even in a large meta-analysis by Cheng et al (21) showing an odds ratio of 0.58 in favour of OPCAB the confidence limits were too wide to allow statistical significance. On the other hand, when comparing biochemical markers of sub-clinical renal damage, evidence from several clinical trials is in favour of OPCAB (11,(60)(61). This difference is clear whether glomerular or tubular damage is compared (60).…”

Effect of Iloprost on Renal Function in Patients Undergoing Coronary Artery Bypass Grafting: A Clinical Study

“…1,3,12,16,17) CPB represents several risk factors on renal physiology including nonpulsatile perfusion, renal hypoperfusion, hypothermia and increased levels of circulating catecholamines, cytokines and free hemoglobin a result of hemolysis. [18][19][20][21] To date, various studies have been done to avoid deleterious effect of cardiopulmonary bypass. Of them, offpump technique for coronary revascularization was popularized in early 1990s, which led to an investigation as to whether the avoidance of CPB altogether would minimize postoperative renal injury and/or insufficiency.…”

The 30 Day Complication Rate After Aortic Valve Replacement with a Pericardial Valve in a Mainly Geriatric Population

“…The extracorporeal circulation could have a damaging effect on the glomeruli, especially if the kidney already has been injured. Mechanisms inflicting renal damage are non-pulsatile perfusion, renal hypoperfusion, hypothermia, and increased levels of circulating catecholamines, cytokines, enzymes, free radicals and free hemoglobin (80). Keeping the cross-clamp time as short as possible or installing a minimal ECC could be helpful (81,82).…”