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Ann Thorac Surg 1999;68:493-498
© 1999 The Society of Thoracic Surgeons
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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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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P. Menasche and L. H. Edmunds Jr. Extracorporeal Circulation: The Inflammatory Response Card. Surg. Adult, January 1, 2003; 2(2003): 349 - 360. [Full Text] |
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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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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] |
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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] |
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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] |
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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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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] |
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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] |
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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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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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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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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] |
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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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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] |
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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] |
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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] |
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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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R. Ascione, G. Nason, S. Al-Ruzzeh, C. Ko, F. Ciulli, and G. D. Angelini Coronary revascularization with or without cardiopulmonary bypass in patients with preoperative nondialysis-dependent renal insufficiency Ann. Thorac. Surg., December 1, 2001; 72(6): 2020 - 2025. [Abstract] [Full Text] [PDF] |
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P. Menasche The systemic factor: the comparative roles of cardiopulmonary bypass and off-pump surgery in the genesis of patient injury during and following cardiac surgery Ann. Thorac. Surg., December 1, 2001; 72(6): S2260 - 2265. [Abstract] [Full Text] [PDF] |
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