Does Off-Pump Coronary Surgery Reduce Postoperative Acute Renal Failure? The Importance of Preoperative Renal Function

Mauro, Michele Di; Gagliardi, Massimo; Iacò, Angela L.; Contini, Marco; Bivona, Antonio; Bosco, Paolo; Gallina, Sabina; Calafiore, Antonio M.

doi:10.1016/j.athoracsur.2007.05.054

Cited by 63 publications

(33 citation statements)

References 24 publications

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“…This precluded evaluating whether the patients in the OPCABG and NOTOUCH groups had a smaller risk of the clinically most significant forms of AKI -including the need for RRT. In contrast to Di Mauro et al 4 , we do not think that choice of surgery using extracorporeal circulation plays a negative role only in patients with normal preoperative renal parameters. We can see the advantages of surgery without extracorporeal circulation in patients with renal impairment pre-operatively.…”

Section: Discussionmentioning

confidence: 60%

“…5,6 ). Impaired glomerular and tubular function is the cause 4 . The reason for this negative effect of CPB on the kidneys is the inflammatory reaction associated with the CPB, non-pulsatile flow of the extracorporeal circulation, haemodilution, possible renal hypoperfusion, atheroembolization and others 7 .…”

Section: Introductionmentioning

confidence: 99%

“…Complications occur in 1.4-19% of operated patients with a predicted mortality of between 7-38% (ref. 4 ). According to the literature, the increased incidence of AKI is associated with the use of extracorporeal circulation (CPB) (ref.…”

Section: Introductionmentioning

confidence: 99%

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Differential impact on acute kidney injury incidence between on- and off pump coronary artery bypass grafting in octogenarians

Špunda¹,

Válek²,

Salmay³

et al. 2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Introduction. Acute kidney injury (AKI) following surgical myocardial revascularization is associated with high mortality and morbidity. The aim of this study was to evaluate the risk of acute kidney injury in a population of very old patients following different surgical techniques. Patients and Methods. A retrospective study of 310 consecutive patients aged 78 to 93 years, mean 80.5±2.2, who underwent surgery at one cardiac surgery centre. Based on the surgical technique used the patients were divided into: Group I. CABG (n=134) -surgical myocardial revascularization using extracorporeal circulation and arterial and venous grafts. Group II. OPCABG (n=55) -surgical revascularization without extracorporeal circulation but using arterial and venous grafts. Group III. NOTOUCH (n=121) -no handling with the ascending aorta was performed at all. Results. A statistically insignificant renoprotective trend was found in patients who underwent surgery without extracorporeal circulation regardless of technique. Comparing groups II and III vs. group I, a significantly poorer renal functioning (median difference in creatinine was 10.0 (32.9) vs 17.5 (35.0), P=0.05) was shown for patients in group I. Conclusion. Surgical myocardial revascularization without extracorporeal circulation in very old patients is safe. The results of this study show a renoprotective trend.

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Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

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Differential impact on acute kidney injury incidence between on- and off pump coronary artery bypass grafting in octogenarians

Špunda¹,

Válek²,

Salmay³

et al. 2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…Importantly, the authors reported that the key to long‐term survival was completeness of revascularization in both on‐ and off‐pump patients. Similarly, in 942 propensity score–matched patient pairs from a single Italian center, there was no difference in 10‐year mortality between on‐ and off‐pump surgery (HR: 1.3; 95% CI, 0.91–1.9) 46. In a study from the United Kingdom of >13 000 propensity‐matched patients followed for 13 years, there was no difference in survival, suggesting that when OPCAB is performed by highly experienced surgeons, there is no adverse effect on survival 47…”

Section: Comparison Of Long‐term Clinical Outcomes Of On‐ and Off‐pummentioning

confidence: 93%

Off‐Pump Coronary Artery Bypass Grafting: 30 Years of Debate

Gaudino

Angelini

Antoniades

et al. 2018

JAHA

Self Cite

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“…Also during preoperative risk of renal injury situations, such enzymes can present small changes and consequently cannot be a sensitive biomarker for screening of renal dysfunction in diabetic or hypertension patients. However, age and hypotensive events were not related to increased tubular enzymes in any of the studied groups Di Mauro et al 19 reported that coronary artery bypass performed without extracorporeal circulation only had a renal protector effect in individuals with normal renal function. When preoperative creatinine is altered, surgical strategy does not determine early or late benefit.…”

Section: Discussionmentioning

confidence: 99%

Enzyme Biomarkers of Renal Tubular Injury in Arterial Surgery Patients

et al. 2011

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Objective: The aim of this study was to verify whether preoperative diabetes, hypertension, and renal function had any relationship with postoperative tubule function in patients submitted to anesthesia for arterial surgery. Methods: Prospective observational study. One hundred and forty-four patients submitted to anesthesia for arterial surgery enrolled consecutively and divided into four groups: G1 -diabetes and hypertension; G2 -diabetes; G3 -hypertension; and G4 -without hypertension or diabetes. Urine was obtained for laboratory analysis of urinary creatinine (Ucr), alkaline phosphatase (AP), g-glutamyltransferase (gGT), and blood for cystatin C and creatinine before the surgery (M1) and 24 h after the surgery (M2). Results: Values of gGT, gGT/Ucr, and AP × gGT/Ucr increased at M2 in G4. Patients without renal function compromise (GFR ≥90 mL/min/1.73 m 2 ) presented increased gGT/Ucr and AP × gGT/Ucr values at M2 and those with slightly compromised renal function (60-89 mL/min/1.73 m 2 ) presented increased gGT values at M2. There was no correlation between deltaCystatin C and deltaAP, deltagGT, deltagGT/Ucr, deltaAP/Ucr, and deltaAP × gGT/Ucr. Conclusions: Diabetes, hypertension, and preoperative renal function seem to interfere in tubular enzymuria immediately after surgery in arteriopathic patients. However, when these markers do not increase in postoperative period, renal dysfunction cannot be discarded.

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Does Off-Pump Coronary Surgery Reduce Postoperative Acute Renal Failure? The Importance of Preoperative Renal Function

Cited by 63 publications

References 24 publications

Differential impact on acute kidney injury incidence between on- and off pump coronary artery bypass grafting in octogenarians

Differential impact on acute kidney injury incidence between on- and off pump coronary artery bypass grafting in octogenarians

Off‐Pump Coronary Artery Bypass Grafting: 30 Years of Debate

Enzyme Biomarkers of Renal Tubular Injury in Arterial Surgery Patients

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