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Ann Thorac Surg 1999;68:493-498
© 1999 The Society of Thoracic Surgeons

Original Articles

On-pump versus off-pump coronary revascularization: evaluation of renal function

Raimondo Ascione, MDa, Clinton T. Lloyd, FRCSa, Malcom J. Underwood, FRCSa, Walter J. Gomes, MDa, Gianni D. Angelini, FRCSa

a Bristol Heart Institute, Bristol Royal Infirmary, Bristol, United Kingdom

Address reprint requests to Dr Angelini, Bristol Heart Institute, Bristol Royal Infirmary, Bristol BS2 8HW United Kingdom
e-mail: g.d.angelini{at}bristol.ac.uk

Background. Coronary revascularization with cardiopulmonary bypass has the potential risk of renal dysfunction related to the nonphysiologic nature of cardiopulmonary bypass. Recently, there has been a revival of interest in performing myocardial revascularization on the beating heart and we investigated whether this prevents renal compromise.

Methods. A prospective, randomized, controlled trial was performed in 50 patients (45 males, mean age 61 ± 3.7 years) undergoing elective coronary artery bypass grafting. Patients were randomly assigned to conventional revascularization with cardiopulmonary bypass (on pump) or beating heart revascularization (off pump). Glomerular and tubular function were assessed up to 48 hours postoperatively.

Results. There were no deaths, myocardial infarctions or acute renal failure in either group. Glomerular filtration as assessed by creatinine clearance and the urinary microalbumin/creatinine ratio was significantly worse in the on pump group (p < 0.0004 and 0.0083, respectively). Renal tubular function was also impaired in the on pump group as assessed by increased N-acetyl glucosaminidase activity (p < 0.0272).

Conclusions. These results suggest that off pump coronary revascularization offers a superior renal protection when compared with conventional coronary revascularization with cardiopulmonary bypass and cardioplegic arrest in first time coronary bypass patients.




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H. K. Song, R. J. Petersen, E. Sharoni, R. A. Guyton, and J. D. Puskas
Safe evolution towards routine off-pump coronary artery bypass: negotiating the learning curve
Eur. J. Cardiothorac. Surg., December 1, 2003; 24(6): 947 - 952.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
J. Boldt, T. Brenner, J. Lang, B. Kumle, and F. Isgro
Kidney-Specific Proteins in Elderly Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass
Anesth. Analg., December 1, 2003; 97(6): 1582 - 1589.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. T. Reston, S. J. Tregear, and C. M. Turkelson
Meta-analysis of short-term and mid-term outcomes following off-pump coronary artery bypass grafting
Ann. Thorac. Surg., November 1, 2003; 76(5): 1510 - 1515.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
D. L. Ngaage
Off-pump coronary artery bypass grafting: the myth, the logic and the science
Eur. J. Cardiothorac. Surg., October 1, 2003; 24(4): 557 - 570.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
S. Al-Ruzzeh, G. Ambler, G. Asimakopoulos, R. Z. Omar, R. Hasan, B. Fabri, A. El-Gamel, A. DeSouza, V. Zamvar, S. Griffin, et al.
Off-Pump Coronary Artery Bypass (OPCAB) Surgery Reduces Risk-Stratified Morbidity and Mortality: A United Kingdom Multi-Center Comparative Analysis of Early Clinical Outcome
Circulation, September 9, 2003; 108(90101): II-1 - 8.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
A. Parolari, F. Alamanni, A. Cannata, M. Naliato, L. Bonati, P. Rubini, F. Veglia, E. Tremoli, and P. Biglioli
Off-pump versus on-pump coronary artery bypass: meta-analysis of currently available randomized trials
Ann. Thorac. Surg., July 1, 2003; 76(1): 37 - 40.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
S. Karthik, G. Musleh, A. D. Grayson, D. J.M. Keenan, R. Hasan, D. M. Pullan, W. C. Dihmis, and B. M. Fabri
Effect of avoiding cardiopulmonary bypass in non-elective coronary artery bypass surgery: a propensity score analysis
Eur. J. Cardiothorac. Surg., July 1, 2003; 24(1): 66 - 71.
[Abstract] [Full Text] [PDF]

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 Asian Cardiovasc. Thorac. Ann.Home page
S. K. Singh, S. K. Mishra, D. Kumar, R. D. Yadave, R. Agarwal, and S. K. Sinha
Total Arterial Revascularization on Beating Heart: Experience in 803 Cases
Asian Cardiovasc Thorac Ann, June 1, 2003; 11(2): 107 - 112.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
R. Ascione and G. D. Angelini
Off-pump coronary artery bypass surgery: The implications of the evidence
J. Thorac. Cardiovasc. Surg., April 1, 2003; 125(4): 779 - 781.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T. Athanasiou, S. Al-Ruzzeh, R. D. Stanbridge, R. P. Casula, B. E. Glenville, and M. Amrani
Is the female gender an independent predictor of adverse outcome after off-pump coronary artery bypass grafting?
Ann. Thorac. Surg., April 1, 2003; 75(4): 1153 - 1160.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
C. S. Rinder, M. Fontes, J. P. Mathew, H. M. Rinder, and B. R. Smith
Neutrophil CD11b upregulation during cardiopulmonary bypass is associated with postoperative renal injury
Ann. Thorac. Surg., March 1, 2003; 75(3): 899 - 905.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. Boldt, T. Brenner, A. Lehmann, S. W. Suttner, B. Kumle, and F. Isgro
Is kidney function altered by the duration of cardiopulmonary bypass?
Ann. Thorac. Surg., March 1, 2003; 75(3): 906 - 912.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
F. F. Immer, A. S. Immer-Bansi, N. Trachsel, P. A. Berdat, V. Eigenmann, M. Curatolo, and T. P. Carrel
Pain treatment with a COX-2 inhibitor after coronary artery bypass operation: a randomized trial
Ann. Thorac. Surg., February 1, 2003; 75(2): 490 - 495.
[Abstract] [Full Text] [PDF]

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 Eur Heart JHome page
R Ascione and G.D Angelini
OPCAB surgery: a voyage of discovery back to the future
Eur. Heart J., January 2, 2003; 24(2): 121 - 124.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. Haase, A. Sharma, A. Fielitz, S. Uchino, J. Rocktaeschel, R. Bellomo, L. Doolan, G. Matalanis, A. Rosalion, B. F. Buxton, et al.
On-pump coronary artery surgery versus off-pump exclusive arterial coronary grafting: a matched cohort comparison
Ann. Thorac. Surg., January 1, 2003; 75(1): 62 - 67.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. Ascione, M. Caputo, and G. D. Angelini
Off-pump coronary artery bypass grafting: not a flash in the pan
Ann. Thorac. Surg., January 1, 2003; 75(1): 306 - 313.
[Abstract] [Full Text] [PDF]

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 Card Surg AdultHome page
P. Menasche and L. H. Edmunds Jr.
Extracorporeal Circulation: The Inflammatory Response
Card. Surg. Adult, January 1, 2003; 2(2003): 349 - 360.
[Full Text]

Home page
 Ann. Thorac. Surg.Home page
M. Caputo, M. Yeatman, P. Narayan, G. Marchetto, R. Ascione, B. C. Reeves, and G. D. Angelini
Effect of off-pump coronary surgery with right ventricular assist device on organ function and inflammatory response: a randomized controlled trial
Ann. Thorac. Surg., December 1, 2002; 74(6): 2088 - 2095.
[Abstract] [Full Text] [PDF]

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 Asian Cardiovasc. Thorac. Ann.Home page
E. Naseri and M. Sevinc
Comparison of Off-Pump Versus Conventional Coronary Revascularization
Asian Cardiovasc Thorac Ann, December 1, 2002; 10(4): 322 - 325.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. J. Mack and F. G. Duhaylongsod
Through the open door! Where has the ride taken us?
J. Thorac. Cardiovasc. Surg., October 1, 2002; 124(4): 655 - 659.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
K.-B. Kim, C. H. Kang, W.-I. Chang, C. Lim, J. H. Kim, B. M. Ham, and Y. L. Kim
Off-pump coronary artery bypass with complete avoidance of aortic manipulation
Ann. Thorac. Surg., October 1, 2002; 74(4): S1377 - 1382.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. Caputo, A. J. Bryan, R. Capoun, B. Mahesh, F. Ciulli, J. Hutter, and G. D. Angelini
The evolution of training in Off-Pump coronary surgery in a single institution
Ann. Thorac. Surg., October 1, 2002; 74(4): S1403 - 1407.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
R. Ascione, B. C. Reeves, K. Rees, and G. D. Angelini
Effectiveness of Coronary Artery Bypass Grafting With or Without Cardiopulmonary Bypass in Overweight Patients
Circulation, October 1, 2002; 106(14): 1764 - 1770.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. Mack, D. Bachand, T. Acuff, J. Edgerton, S. Prince, T. Dewey, and M. Magee
Improved outcomes in coronary artery bypass grafting with beating-heart techniques
J. Thorac. Cardiovasc. Surg., September 1, 2002; 124(3): 598 - 607.
[Abstract] [Full Text] [PDF]

Home page
 Asian Cardiovasc. Thorac. Ann.Home page
Z. S Meharwal and N. Trehan
Off-Pump Coronary Artery Surgery in the Elderly
Asian Cardiovasc Thorac Ann, September 1, 2002; 10(3): 206 - 210.
[Abstract] [Full Text] [PDF]

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 HeartHome page
P. P T. de Jaegere and W. J L Suyker
OFF-PUMP CORONARY ARTERY BYPASS SURGERY
Heart, September 1, 2002; 88(3): 313 - 318.
[Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
A.T.M. Tang, J. Knott, J. Nanson, J. Hsu, M.P. Haw, and S.K. Ohri
A prospective randomized study to evaluate the renoprotective action of beating heart coronary surgery in low risk patients
Eur. J. Cardiothorac. Surg., July 1, 2002; 22(1): 118 - 123.
[Abstract] [Full Text] [PDF]

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 PerfusionHome page
R. Ascione, S. Al-Ruzzeh, K. Amer, and G. D Angelini
Subsystem organ function during coronary surgery
Perfusion, July 1, 2002; 17(4): 295 - 303.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. H. Chamberlain, R. Ascione, B. C. Reeves, and G. D. Angelini
Evaluation of the effectiveness of off-pump coronary artery bypass grafting in high-risk patients: an observational study
Ann. Thorac. Surg., June 1, 2002; 73(6): 1866 - 1873.
[Abstract] [Full Text] [PDF]

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 ChestHome page
B. G. Loef, A. H. Epema, G. Navis, T. Ebels, W. van Oeveren, and R. H. Henning
Off-Pump Coronary Revascularization Attenuates Transient Renal Damage Compared With On-Pump Coronary Revascularization*
Chest, April 1, 2002; 121(4): 1190 - 1194.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
C. Koksoy, S. A. LeMaire, P. E. Curling, S. A. Raskin, Z. C. Schmittling, L. D. Conklin, and J. S. Coselli
Renal perfusion during thoracoabdominal aortic operations: cold crystalloid is superior to normothermic blood
Ann. Thorac. Surg., March 1, 2002; 73(3): 730 - 738.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. J. Novick, S. A. Fox, L. W. Stitt, B. B. Kiaii, S. A. Swinamer, R. Rayman, T. R. Wenske, and W. D. Boyd
Assessing the learning curve in off-pump coronary artery surgery via CUSUM failure analysis
Ann. Thorac. Surg., January 1, 2002; 73(1): S358 - 362.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
H. Hirose, A. Amano, and A. Takahashi
Off-pump coronary artery bypass grafting for elderly patients
Ann. Thorac. Surg., December 1, 2001; 72(6): 2013 - 2019.
[Abstract] [Full Text] [PDF]


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