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Ann Thorac Surg 2004;78:2044-2049
© 2004 The Society of Thoracic Surgeons

Original Article: Cardiovascular

Off-Pump Coronary Artery Bypass Grafting in Patients With Renal Dysfunction

Minoru Tabata, MD*, Shuichiro Takanashi, MD, Toshihiro Fukui, MD, Tetsuya Horai, MD, Tomoya Uchimuro, MD, Katsukiyo Kitabayashi, MD, Yasuyuki Hosoda, MD

Department of Cardiovascular Surgery, Shin-Tokyo Hospital, Chiba, Japan

Accepted for publication June 11, 2004.

* Address reprint requests to Dr Tabata, Division of Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA02446 (E-mail: mtab-tky{at}umin.ac.jp).


   Abstract
Top
 Abstract
Introduction
 Material and Methods
 Results
 Comment
 References
 
BACKGROUND: Renal dysfunction is a predictor of increased morbidity and mortality after coronary artery bypass grafting, whether it is dialysis-dependent or not. Several studies have shown the efficacy of off-pump technique in reducing morbidity and mortality in patients with renal dysfunction. However, the actual effect of renal dysfunction in off-pump coronary artery bypass grafting has not been well understood.

METHODS: We conducted a retrospective review of 402 consecutive patients undergoing off-pump coronary artery bypass grafting from April 2001 to June 2003. Sixty-eight patients had chronic renal dysfunction (group A); 19 patients were dialysis-dependent; 334 patients had normal renal function (group B). Operative variables, morbidity, and mortality were compared between the two groups. Furthermore, multivariable analysis was performed to identify predictors for short-term survival.

RESULTS: Preoperative characteristics were similar in the two groups. Blood transfusion rate was higher in group A than group B (57.4% and 25.7%, respectively; p < 0.001). In-hospital mortality was similar (1.5% and 1.2% in group A and B, respectively; p = 0.853). Multivariable analysis revealed that unstable angina, low ejection fraction, peripheral vascular disease and redo surgery are significant risk factors for poor early result of off-pump coronary artery bypass grafting.

CONCLUSIONS: Early outcomes of off-pump coronary artery bypass grafting in patients with renal dysfunction were comparable to those in patients with normal renal function. Renal dysfunction is not a predictor of poor early outcomes after off-pump coronary artery bypass grafting.


   Introduction
Top
 Abstract
 Introduction
Material and Methods
 Results
 Comment
 References
 
Coronary artery bypass surgery (CABG) in patients with renal dysfunction has been extensively reported to have high morbidity and mortality rate [1–9]. Renal dysfunction has been shown to be an independent predictor of poor results after CABG [1–3, 5–9]. Recently, the benefits of off-pump CABG (OPCAB) has been well established, and several studies have revealed that OPCAB has better outcomes in patients with renal dysfunction than conventional CABG [7, 10–13]. Is renal dysfunction still a predictor of poor results after CABG in the era of off-pump technique? The purpose of this retrospective study is to assess the impact of renal function on outcomes of OPCAB.


   Material and Methods
Top
 Abstract
 Introduction
 Material and Methods
Results
 Comment
 References
 
Patients
Between April 2001 and June 2003, 402 consecutive patients underwent OPCAB at our hospital: 68 patients had chronic renal dysfunction (group A); 19 were dialysis dependent; and 334 patients had normal renal function (group B). Renal dysfunction was diagnosed when preoperative serum creatinine of 1.5 mg/dL or more was confirmed in at least two measurements performed on different days. Smoking history included current smoking history and past smoking history within 1 year before the surgery. Emergency surgery was defined as a nonelective operation performed within 24 hours after admission. Preoperative characteristics of patients were compared between the two groups.

Surgical Procedures
Off-pump coronary artery bypass was performed mostly through median sternotomy. Left thoracotomy approach was used in a few cases. All the arterial conduits were harvested with skeletonization technique using Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH). Saphenous vein grafts (SVG) were harvested with open method using fine scissors. Our strategies for selection of conduits were as follows: in situ left internal mammary artery (LIMA) was used for left anterior descending artery; in situ right internal mammary artery (RIMA) was used for other branches of left coronary artery; If preoperative coronary angiogram had shown that in situ RIMA was not long enough to reach targeted vessels, radial artery (RA) was used instead; RA was proximally anastomosed to the aorta. If the aorta was not available, RA was anastomosed to IMA or right gastroepiproic artery (GEA) as a Y-graft or I-graft; GEA, RA or SVG was used for right coronary artery system; If RA was not available, RIMA was used as a free graft; RA was not used in patients with positive Allen's test, RA of less than 2 mm in diameter, chronic dialysis or serum creatinine level of 2.5 mg/dL or more; SVG was used when arterial conduits were not available. The availability of the aorta was evaluated with the epiaortic ultrasound in all the cases. The Starfish and Octopus (Medtronic, Inc, Minneapolis, MN) were used to position and stabilize the beating heart during anastomoses.

Perioperative Dialysis
All the dialysis patients were maintained on hemodialysis by arteriovenous fistula in the upper extremity and underwent it on the day before the surgery as usual. One of them who had emergency surgery underwent intraoperative continuous venovenous hemodiafiltration (CVVHD) through a 12Fr double-lumen catheter placed in the femoral vein. Postoperative dialysis for chronic dialysis patients was done on the operative day if they had volume overload or uncontrollable hyperkalemia. If not, it was done on the day after surgery or the next. Postoperative dialysis for nondialysis patients was indicated if they had diuretics-resistant oliguria associated with volume overload or hyperkalemia. Intermittent hemodialysis was performed in hemodynamically stable patients and CVVHD was performed in hemodynamically unstable patients.

Outcomes
In-hospital outcomes were collected from the medical records. Postdischarge outcomes were collected from the medical records and telephone interviews. Complete revascularization was defined as full grafting into any system with 50% or more stenotic lesions. Cardiac-related event included cardiac death, angina, acute myocardial infarction, percutaneous coronary interventions and redo CABG. Myocardial infarction was diagnosed with a rise in the level of the myocardial-bound isoenzyme of creatine kinase. Angina was diagnosed when typical symptoms accompanied with new ST and T-wave changes on the electrocardiogram or new coronary lesion on the angiogram were found. Operative variables, the length of intensive care unit (ICU) stay, operative morbidity and mortality, and short-term survival and cardiac-related event free rate were compared between the two groups. The length of postoperative hospital stay was not compared in this study because it was determined by nonmedical issues.

Statistical Analysis
Values of continuous variables are expressed as mean ± standard deviation. Unpaired t test and Mann-Whitney test were used to analyze continuous variables. A {chi}2 test was used to analyze categorical variables. Kaplan-Meier model with the log rank test was used to analyze survival rate and cardiac-related event free rate. Cox proportional hazard model was used to determine significant predictors for short-term mortality. Regarding explanatory variables, preoperative creatinine and chronic dialysis were entered first, and then other variables were selected with a backward stepwise method. A value of p was considered statistically significant when it was less than 0.05. Statistical analysis was performed with SPSS version 11.5J (SPSS, Inc, Chicago, IL).


   Results
Top
 Abstract
 Introduction
 Material and Methods
 Results
Comment
 References
 
Preoperative Characteristics
Preoperative characteristics of patients are shown in Table 1. New York Heart Association functional class and ejection fraction were poorer in group A than group B, and the history of congestive heart failure was more frequent in group A than group B. There was no significant difference in other variables between the two groups.


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  		Table 1. Comparison of Preoperative Characteristics by Patient Groups
 
Operative Variables
Operative variables of patients are listed in Table 2. The number of grafts were 3.7 ± 1.4 and 3.7 ± 1.5 in groups A and B, respectively (p = 0.864). RIMA was more frequently used in group A than group B. RIMA was used in 94.7% of dialysis-dependent patients. 66.7% of RIMAs harvested in dialysis-dependent patients was used as a free graft. Bilateral IMAs were more frequently used in group A than group B. RA was less frequently used in group A than group B because RA was not used in patients with chronic dialysis or severe renal dysfunction as a policy. SVG was more frequently used in group A than group B. The use of LIMA and GEA was similar in the two groups. Total arterial revascularization was less frequently performed in group A than group B. Complete revascularization was performed in 95.6% of group A, and 96.7% of group B (p = 0.647). There was no significant difference in the use of sequential grafts and composite grafts such as Y-grafts and I-grafts between the two groups. The perioperative blood transfusion rate was higher in group A than group B. 94.7% of dialysis-dependent patients received blood transfusion. The amount of transfused red blood cells was significantly larger in group A than group B. The amount of transfused fresh frozen plasma and platelets was also larger in group A than group B, however the differences were not significant (Table 2).


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  		Table 2. Operative Data
 
Outcomes
Postoperative angiography was performed within 1 month after surgery in 69.1% of group A and 86.8% of group B. It was less frequently performed in group A than group B because the contrast medium could damage their preserved renal function. Early graft patency rates were excellent in both groups (Table 3).


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  		Table 3. Early Graft Patency Rates
 
In-hospital mortalities were 1.5% and 1.2% in group A and B, respectively (p = 0.853). The incidence of low output syndrome, perioperative myocardial infarction, stroke, mediastinitis, superficial would complication, and atrial fibrillation was similar in two groups. The incidence of respiratory failure and postoperative bleeding requiring reexploration was more frequent in group A than group B although the difference was not statistically significant. Postoperative dialysis was performed in 10.2% (5/49) of patients with nondialysis dependent renal dysfunction and 0.9% (3/334) of patients with normal renal function (p < 0.001). Chronic dialysis was not required for those patients. CVVHD was required for 3 chronic dialysis patients including an emergency case, and 2 nondialysis-dependent renal dysfunction patients.

The time to extubation was 9.6 ± 7.9 hours in group A and 11.8 ± 8.1 hours in group B (p = 0.042). The length of ICU stay was 2.8 ± 2.0 days in group A and 2.3 ± 1.1 day in group B (p = 0.010; Table 4).


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  		Table 4. In-Hospital Morbidities, Mortalities, and Length of Stay
 
The mean follow-up period was 11.7 ± 7.6 months. Actuarial survival rates at 1 year were 96.2% and 96.7% in group A and B, respectively (p = 0.427). Cardiac-related event-free rates at 1 year were 94.4% and 95.4% in groups A and B, respectively (p = 0.992). Cox proportional hazards model revealed that unstable angina, low ejection fraction, peripheral vascular disease and redo surgery were significant predictor for short-term mortality after OPCAB and that preoperative creatinine or chronic dialysis was not significantly related to short-term mortality after OPCAB (Table 5).


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  		Table 5. Predictors of Short-Term Mortality
 

   Comment
Top
 Abstract
 Introduction
 Material and Methods
 Results
 Comment
References
 
Dialysis-dependent renal dysfunction is widely recognized to increase morbidity and mortality after conventional CABG [1–5]. Also, nondialysis-dependent renal dysfunction has been reported to predispose patients to adverse results after CABG [6–9]. On the other hand, several studies have recently demonstrated that OPCAB provides better results in patients with renal dysfunction than conventional CABG [7, 10–13]. These excellent studies indicated the efficacy of OPCAB by comparing outcomes of OPCAB to those of conventional CABG. However, they did not show the actual effect of renal dysfunction on outcomes of OPCAB. The purpose of this study is to evaluate whether renal dysfunction makes an adverse effect on short-term results of OPCAB.

This study has demonstrated some characteristics in selection of conduits in patients with renal dysfunction. Bilateral IMAs and SVG were frequently used, and RA was not used in patients with chronic dialysis or serum creatinine of 2.5 mg/dL or more because of future use of RA for blood access of dialysis. The benefits of bilateral IMAs have been well established [14–16]. Furthermore, Nakayama and associates [17] have shown that the use of bilateral IMAs in chronic dialysis patients does not cause additional operative complications such as mediastinitis. In this study, the incidence of mediastinitis and superficial wound complication was not increased in patients with renal dysfunction despite frequent bilateral IMAs harvest, which supports the previous report. On the other hand, the disadvantage of SVG use in late outcome of CABG has become evident [18, 19], and RA has been shown to provide better results than free RIMA [20]. This selection of conduits could cause some adverse effects on late outcomes in our patients with renal dysfunction.

In most previous studies investigating the efficacy of OPCAB in patients with renal dysfunction, the number of grafts in OPCAB was significantly less than that of conventional CABG [7, 12, 13, 21]. Sabik and associates [22] have reported increased occurrence of incomplete revascularization in OPCAB that could be harmful for late results. In this study, the number of grafts was larger than that of previous studies and complete revascularization was carried out in 96.5% of all the patients (388/402), which did not increase operative complications or decrease graft patency rates. The safe techniques for multivessel complete revascularization in OPCAB have been established [23]. This should be indicated for patients with renal dysfunction.

Operative mortalities of conventional CABG have been reported to range from 5.9% to 14.3% in patients with chronic dialysis [1–5] and from 7.0% to 11.0% in patients with nondialysis-dependent renal dysfunction [6–9, 12, 13]. Some studies have reported better outcomes, however they are much smaller studies [11, 21]. Operative mortalities of OPCAB have been recently reported to range from 0% to 6.7% in patients with chronic dialysis [11, 12, 21] and to range from 5.9% to 6.3% in patients with nondialysis-dependent renal dysfunction [7, 13].

In this study, in-hospital mortality rate was 1.5% in patients with renal dysfunction. We had one in-hospital death in chronic dialysis patients. The patient was a 74-year-old man who had unstable angina and severe diffuse triple-vessel disease associated with diabetes, peripheral vascular disease, and low ejection fraction of 36%. He developed poststernotomy mediastinitis, and then underwent wound debridement and omental flap surgery. Finally, he died of respiratory failure 5 months after the first surgery. Franga and associates have suggested that CABG should be avoided in dialysis patients with severe diffuse disease [4]. In this study, 7 dialysis patients with severe diffuse disease underwent OPCAB; 1 died during hospitalization (mortality: 14.3%) and the other 6 patients survived during follow-up period. The risk of OPCAB in dialysis patients with severe diffuse disease should be further investigated.

Twenty-seven patients received postoperative dialysis in this study; 19 had chronic dialysis-dependent renal dysfunction, 5 had nondialysis dependent renal dysfunction, and the others had normal renal function preoperatively. Only 5 patients among them (18.5%) received CVVHD because of unstable hemodynamic status. Only 6 patients (22.2%) received dialysis immediately after the surgery, and all of them were chronic dialysis patients. The others received it more than 12 hours after the surgery. Furthermore, chronic dialysis was not required for any patients with nondialysis-dependent renal dysfunction or normal renal function. Ascione and associates [25] have suggested that glomerular filtration and tubular function are impaired by cardiopulmonary bypass, and OPCAB provides a superior renal protection compared to conventional on-pump CABG [24]. Also, they have demonstrated that OPCAB reduces in-hospital morbidity and postoperative acute renal failure in patients with nondialysis-dependent renal dysfunction [13]. On the other hand, Tang and associates [25] have demonstrated that avoidance of cardiopulmonary bypass does not offer additional renoprotection in CABG patients at low risk. Although renoprotective effect of OPCAB is controversial, our results support the former. In addition to renoprotective effect, OPCAB seems to provide stable postoperative hemodynamic status. Those effects allowed us to avoid expensive CVVHD and immediate postoperative dialysis that could predispose patients to bleeding or hemodynamic unstability.

Patients with renal dysfunction had longer ICU stay and intubation time than those with normal renal function. The incidence of respiratory failure and postoperative bleeding tended to be more frequent in patients with renal dysfunction than those with normal renal function although there was no significant difference. Five patients with renal dysfunction received postoperative CVVHD that was performed exclusively in the ICU, while no patients with normal renal function received CVVHD. Our results suggest that renal dysfunction makes postoperative course some complicated even if cardiopulmonary bypass is not used.

Renal dysfunction has been found to increase the requirement of blood transfusion [6]. On the other hand, OPCAB has been reported to reduce the incidence of blood transfusion requirement compared with conventional CABG [10, 12, 23]. In this study, perioperative blood transfusion rate in patients with renal dysfunction was high, especially in dialysis patients. Mean transfused unit of red blood cells was significantly larger in patients with renal dysfunction than patients with normal renal function. Also, that of fresh frozen plasma and platelets was larger although there was no significant difference. Considering the incidence of postoperative bleeding, the high blood transfusion rate in patients with renal dysfunction seems to be due to not only preoperative anemia but also hemorrhagic tendency from platelet dysfunction. Our results suggest that OPCAB does not reduce the requirement of blood transfusion in patients with renal dysfunction.

One of the important limitations of this study is that we did not investigate late outcomes. There have been only a few studies demonstrating remote results of OPCAB in patients with renal dysfunction. Hirose and associates have shown that 2-year actuarial survival rate was 88.9% and 2-year cardiac-related event-free rate was 100% in dialysis patients undergoing OPCAB. Several studies have revealed poor late outcomes of conventional CABG in patients with renal dysfunction. 5-year actuarial survival rates of dialysis patients have been reported to range from 32.0% to 55.8% [2, 4, 5]. Nakayama and associates have shown 10-year actuarial survival rate of 29% in patients with chronic dialysis and that of 32% in patients with nondialysis-dependent renal dysfunction. They have also suggested that aggressive use of arterial grafts, especially IMA, would improve late outcomes [9]. Regarding late outcomes of OPCAB in patients with renal dysfunction, further investigation is expected. Another limitation of this study is the small number of patients with renal dysfunction. Propensity matching was not used in statistical analyses because of the small number of patients.

In conclusion, off-pump complete revascularization in patients with renal dysfunction provides low operative morbidity and mortality, excellent graft patency and short-term survival. Renal dysfunction is not a predictor for short-term survival of OPCAB, although it could predispose patients to longer intubation time, longer ICU stay, and more frequent use of blood transfusion.


   References
Top
 Abstract
 Introduction
 Material and Methods
 Results
 Comment
 References
 

  1. Liu JY, Birkmeyer NJ, Sanders JH, et al. Risks of morbidity and mortality in dialysis patients undergoing coronary artery bypass surgeryNorthern New England Cardiovascular Disease Study Group. Circulation 2000;102:2973-2977.[Abstract/Free Full Text]
  2. Labrousse L, de Vincentiis C, Madonna F, Deville C, Roques X, Baudet E. Early and long term results of coronary artery bypass grafts in patients with dialysis dependent renal failure Eur J Cardiothorac Surg 1999;15:691-696.[Abstract/Free Full Text]
  3. Khaitan L, Sutter FP, Goldman SM. Coronary artery bypass grafting in patients who require long-term dialysis Ann Thorac Surg 2000;69:1135-1139.[Abstract/Free Full Text]
  4. Franga DL, Kratz JM, Crumbley AJ, Zellner JL, Stroud MR, Crawford FA. Early and long-term results of coronary artery bypass grafting in dialysis patients Ann Thorac Surg 2000;70:813-819.[Abstract/Free Full Text]
  5. Dacey LJ, Liu JY, Braxton JH, et al. Long-term survival of dialysis patients after coronary bypass grafting Ann Thorac Surg 2002;74:458-463.[Abstract/Free Full Text]
  6. Rao V, Weisel RD, Buth KJ, et al. Coronary artery bypass grafting in patients with non-dialysis-dependent renal insufficiency Circulation 1997;96(9 Suppl):II38-45.
  7. Hirose H, Amano A, Takahashi A, Nagano N. Coronary artery bypass grafting for patients with non-dialysis-dependent renal dysfunction (serum creatinine ≥ 2.0 mg/dL) Eur J Cardiothorac Surg 2001;20:565-572.[Abstract/Free Full Text]
  8. Weerasinghe A, Hornick P, Smith P, Taylor K, Ratnatunga C. Coronary artery bypass grafting in non-dialysis-dependent mild-to-moderate renal dysfunction J Thorac Cardiovasc Surg 2001;121:1083-1089.[Abstract/Free Full Text]
  9. Nakayama Y, Sakata R, Ura M, Ito T. Long-term results of coronary artery bypass grafting in patients with renal insufficiency Ann Thorac Surg 2003;75:496-500.[Abstract/Free Full Text]
  10. Yokoyama T, Baumgartner FJ, Gheissari A, Capouya ER, Panagiotides GP, Declusin RJ. Off-pump versus on-pump coronary bypass in high-risk subgroups Ann Thorac Surg 2000;70:1546-1550.[Abstract/Free Full Text]
  11. Tashiro T, Nakamura K, Morishige N, et al. Off-pump coronary artery bypass grafting in patients with end-stage renal disease on hemodialysis J Card Surg 2002;17:377-382.[Medline]
  12. Hirose H, Amano A, Takahashi A. Efficacy of off-pump coronary artery bypass grafting for the patients on chronic hemodialysis Jpn J Thorac Cardiovasc Surg 2001;49:693-699.[Medline]
  13. Ascione R, Nason G, Al-Ruzzeh S, Ko C, Ciulli F, Angelini GD. Coronary revascularization with or without cardiopulmonary bypass in patients with preoperative nondialysis-dependent renal insufficiency Ann Thorac Surg 2001;72:2020-2025.[Abstract/Free Full Text]
  14. Pick AW, Orszulak TA, Anderson BJ, Schaff HV. Single versus bilateral internal mammary artery grafts: 10-year outcome analysis Ann Thorac Surg 1997;64:599-605.[Abstract/Free Full Text]
  15. Buxton BF, Komeda M, Fuller JA, Gordon I. Bilateral internal thoracic artery grafting may improve outcome of coronary artery surgeryRisk-adjusted survival. Circulation 1998;98(19 Suppl):II1-6.
  16. Lytle BW, Blackstone EH, Loop FD, et al. Two internal thoracic artery grafts are better than one J Thorac Cardiovasc Surg 1999;117:855-872.[Abstract/Free Full Text]
  17. Nakayama Y, Sakata R, Ura M. Bilateral internal thoracic artery use for dialysis patients: does it increase operative risk? Ann ThoracSurg 2001;71:783-787.[Abstract/Free Full Text]
  18. Muneretto C, Bisleri G, Negri A, et al. Total arterial myocardial revascularization with composite grafts improve results of coronary surgery in elderly: a prospective randomized comparison with conventional coronary artery bypass surgery Circulation 2003;108(Suppl 1):II29-33.
  19. Tatoulis J, Buxton BF, Fuller JA. Patencies of 2,127 arterial to coronary conduits over 15 years Ann Thorac Surg 2004;77:93-9101.[Abstract/Free Full Text]
  20. Caputo M, Reeves B, Marchetto G, Mahesh B, Lim K, Angelini GD. Radial versus right internal thoracic artery as a second arterial conduit for coronary surgery: early and midterm outcomes J Thorac Cardiovasc Surg 2003;126:39-47.[Abstract/Free Full Text]
  21. Papadimitriou LJ, Marathias KP, Alivizatos PA, et al. Safety and efficacy of off-pump coronary artery bypass grafting in chronic dialysis patients Artif Organs 2003;27:174-180.[Medline]
  22. Sabik JF, Gillinov AM, Blackstone EH, et al. Does off-pump coronary surgery reduce morbidity and mortality? J Thorac Cardiovasc Surg 2002;124:698-707.[Abstract/Free Full Text]
  23. Puskas JD, Williams WH, Duke PG, et al. Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: A prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting J Thorac Cardiovasc Surg 2003;125:797-808.[Abstract/Free Full Text]
  24. Ascione R, Lloyd CT, Underwood MJ, Gomes WJ, Angelini GD. On-pump versus off-pump coronary revascularization: evaluation of renal function Ann Thorac Surg 1999;68:493-498.[Abstract/Free Full Text]
  25. Tang AT, Knott J, Nanson J, Hsu J, Haw MP, Ohri SK. A prospective randomized study to evaluate the renoprotective action of beating heart coronary surgery in low risk patients Eur J Cardiothorac Surg 2002;22:118-123.[Abstract/Free Full Text]



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