Ann Thorac Surg 2005;80:2153-2154
© 2005 The Society of Thoracic Surgeons
Original article: Cardiovascular
Invited commentary
Mark Stafford-Smith, MD
Duke University Medical Center, Department of Anesthesiology, Box 3094 DUMC, Durham, NC27710
(Email: staff002{at}mc.duke.edu).
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Introduction
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Less invasive coronary artery bypass surgeries that do not require circulatory support have not had a large impact on the incidence of postoperative acute renal failure requiring dialysis in the general coronary artery bypass surgery population. Although early reports of subtle reductions in renal insult and promising findings from nonrandomized outcome studies hinted at benefit, enough published data now exists, including meta-analyses of randomized trials, to confirm that no meaningful advantage exists. However the problem with this conclusion is that it ignores the question of most importance to the clinician: does off-pump surgery confer benefit for the patient at high renal risk, when even subtle improvements may make a difference? The current report by Chukwuemeka and colleagues [1] is one of the rare studies that compares postoperative renal impairment in a large patient group with baseline renal dysfunction undergoing on-pump and off-pump procedures. Of course, as with many studies in this area, this study suffers from a nonrandomized design, but the authors are to be commended for their approach using a propensity score analysis to adjust for differences in patient characteristics. The authors conclude that even in this patient group, at high renal risk, off-pump procedures do not seem to confer any significant degree of renal protection, and therefore renal risk should not be an important factor influencing the selection of coronary artery bypass procedure. Until the results of large, randomized studies are available to address this question, these findings are the best data available in this area and continue to support the observation that off-pump surgery does not have a big impact on perioperative renal risk.
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Notice From the American Board of Thoracic Surgery
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The 2005 Part I (written) examination will be held on Monday, December 5, 2005. It is planned that the examination will be given at multiple sites throughout the United States using an electronic format. The closing date for registration was August 1, 2005. Those wishing to be considered for examination must apply online at www.abts.org.
To be admissible to the Part II (oral) examination, a candidate must have successfully completed the Part I (written) examination.
A candidate applying for admission to the certifying examination must fulfill all the requirements of the Board in force at the time the application is received.
Please address all communications to the American Board of Thoracic Surgery, 6333 N St. Clair St, Suite 2320, Chicago, IL 60611; telephone: (312) 202-5900; fax: (312) 202-5960; e-mail: mailto:info{at}abts.org.
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References
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- Chukwuemeka A, Weisel A, Maganti M, et al. Renal dysfunction in high-risk patients after on-pump and off-pump coronary artery bypass surgerya propensity score analysis. Ann Thorac Surg 2005;80:2148-2154.[Abstract/Free Full Text]
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J. H. Khan, E. A. Davis, L. S. Dean, M. J. Huff, N. Y. Khan, and A. Rehman
The Role of Elective Perioperative Dialysis in Nondialysis Renal Failure Patients
Ann. Thorac. Surg.,
April 1, 2009;
87(4):
1085 - 1089.
[Abstract]
[Full Text]
[PDF]
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Introduction
Notice From the American...