Key result
Off-pump CABG is linked to ~39 minutes longer operation time vs on-pump but preserves renal function.
Why the study?
To compare early results of isolated on-pump versus off-pump CABG in patients with preoperative mild-to-moderate serum creatinine elevation not requiring maintenance dialysis.
Does off-pump CABG prevent postoperative renal dysfunction compared to on-pump CABG in patients with coronary artery disease and early-stage renal impairment?
Observational (n=60)
No
Does off-pump CABG prevent postoperative renal dysfunction compared to on-pump CABG in patients with coronary artery disease and early-stage renal impairment?
Absolute Event Rate: 273.77% vs 234.6%
p-value: p=0.004
Off-pump CABG may be preferable to on-pump CABG for preserving renal function in patients with pre-existing mild-to-moderate renal impairment undergoing surgical revascularization.
Off-pump CABG was associated with better early renal preservation; leaves open whether it should be preferred in mild impairment pending randomized confirmation.
BackgroundCoronary artery disease is the most common of the cardiovascular diseases that can be treated with coronary artery bypass grafting (CABG) surgery, with either on-pump or off-pump technique. In this study, we aimed to compare the early results of isolated CABG, using on-pump and off-pump techniques, in patients with preoperative mild-to-moderate elevation of serum creatinine (1.6–2.5 mg/dl) level who did not require maintenance dialysis to support renal function.Patients and methodsThis prospective nonrandomized study included 60 patients who complained of symptoms of coronary artery disease and subsequently underwent myocardial revascularization at Cardiothoracic Surgery Department, Shebin El-Kom Teaching Hospital, Menoufia, Egypt, between June 2017 and August 2018.ResultsIn group A (the on-pump group), the mean age was 73.40 ± 6.38 years, whereas in group B (the off-pump group), the mean age was 72.87 ± 9.62 years. The mean of total pump time was 112.40 ± 37.80 min and the mean of total ischemic time was 67.50 ± 24.18 min Regarding the operation time, the mean of on-pump CABG operation time was 234.60 ± 57.54 min, and 273.77 ± 43.07 min for the off-pump CABG operation, with statistically significant difference (P = 0.004). The mean time of ICU stay was 4.66 ± 3.36 days in the on-pump CABG and 3.70 ± 2.15 days in the off-pump CABG group, with no statistically significant difference between the two groups (P = 0.191).ConclusionRegarding postoperative renal dysfunction and need for dialysis, results were in favor of the off-pump technique. Renal function is better preserved in patients undergoing off-pump CABG than those undergoing on-pump CABG.
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Ashraf Zahra (2019) conducted an observational in Coronary artery disease with early-stage renal impairment (n=60). Off-pump coronary artery bypass grafting vs. On-pump coronary artery bypass grafting was evaluated on Operation time (p=0.004). Off-pump CABG was associated with a significantly longer operation time compared to on-pump CABG (273.77 vs 234.60 min; P=0.004), though authors concluded it better preserved renal function.
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