Does off-pump coronary artery bypass grafting attenuate renal damage compared to on-pump CABG?

Abstract

Background:Because of a concern about the ability of the heart to tolerate grafting on beating heart, patients with significant left main coronary artery stenosis (LMCA) have been excluded from off-pump bypass by many surgeons in their initial phase of experience. We reviewed our experience with off-pump coronary artery bypass grafting (OPCAB) for patients with critical LMCA disease and/or associated with co-morbid conditions.Methods: A total of 257 patients underwent CABG for significant (>50%) LMCA stenosis from January 2001 through October 2005. Of these, 131 patients (group 1) were revascularized on beating heart without use of CPB and 126 patients (group II) underwent CABG with use of CPB. In group 1,65 patients were high risk for CABG: 36 patients had critical (>90%) LMCA stenosis, 11 patients had severe LV dysfunction (LVEF < 35%), 7 patients had non-dialysis dependent renal insufficiency, 10 patients had COPD, 3 patients had h/o CVA, 5 patients were obese and 4 patients underwent re-operative CABG. 62 patients in group II were high risk for surgery. All patients had multivessel grafting performed through standard median sternotomy. Tissue stabilizers, intra coronary shunts and pericardial traction stich exposure techniques were used in all patients. Early outcomes were analysed and compared between the two groups.Results: The groups were similar in terms of demographic and preoperative risk factors. Offpump patients received less number of grafts compared to on-pump group (2.92 ± 0.8 vs 3.45 ± 0.83: p < 0.001). Inotropic requirement was higher in on-pump group (40/62 vs 30/ 65 : p 0.096), deterioration in renal function was less in OPCAB group compared to on-pump group (p 0.001). Requirement of blood transfusion was less in OPCAB group (p 0.0001). There was one death in on-pump group and none in OPCAB group (p 0.98) Conclusions: Coronary artery bypass grafting using off-pump technique is safe, effective and reproducible in patients with critical LMCA stenosis even in association with co-morbid conditions.