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Impact of on-pump versus off-pump coronary artery bypass grafting on postoperative early acute kidney injury



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Impact of on-pump versus off-pump coronary artery bypass grafting on postoperative early acute kidney injury


XI Lei WANG Zhengqing LIU Zhigang LIANG Shaojie TENG

LeiDepartment of Cardiovascular Surgery, Teda International Cardiovascular Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Tianjin, 300457, China


acute kidney injury coronary artery bypass grafting extracorporeal circulation prognosis


ObjectiveTo compare the postoperative renal outcomes after on-pump versus conventional offpump coronary artery bypass grafting (CABG) and analyze the risk factors of acute kidney injury (AKI) following CABG. MethodsThe clinical data were retrospectively reviewed for 588 patients [including 425 male and 163 female patients with a mean body mass of (72.57±11.85) kg and a mean age of (67.21±9.35) years] with coronary heart diseases undergoing CABG in our department between January, 2013 and December, 2016. The perioperative data of the patients receiving on-pump CABG and off-pump CABG were compared and the risk factors of postoperative AKI were identified using univariate analysis and logistic regression analysis. ResultsThe overall incidence of AKI after CABG was 12.1% (71/588) in these patients, and the incidence was significantly lower in the off-pump group than in the on-pump group [6.3%(12/192) vs 14.9%(59/396), P<0.05]. Univariate and multivariate regression analyses identified the application of extracorporeal circulation (OR=0.481, 95%CI: 0.244~0.950, P=0.035), a history of hypertension (OR=2.793, 95%CI: 1.402~5.565,  P=0.03), left atrial diameter (OR=1.063, 95%CI: 1.004~1.126, P=0.036), left carotid artery stenosis (OR=2.139, 95%CI: 1.214~3.769, P=0.00), distal venous bridge anastomotic number (OR=1.681, 95%CI: 1.225~2.306, P=0.001) and the use of blood products (OR=4.421, 95%CI: 1.839~10.625, P=0.001) as the independent risk factors for postoperative AKI. ConclusionOffpump beatingheart CABG achieves better shortterm renal outcomes than conventional on-pump CABG, and the preoperative baseline and general condition of the patients should be considered in the surgical planning.


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Last Update: 2018-07-03