Is Off-Pump Revascularization Better for Patients with Non-Dialysis-Dependent Renal Insufficiency?

Beauford, Robert B.; Saunders, Craig R.; Niemeier, Leo A.; Lunceford, Troy Adam; Karanam, Ravindra; Prendergast, Thomas A.; Shah, Shamji; Burns, Paul; Sardari, Frederick; Goldstein, Daniel J.

doi:10.1532/hsf.1134

Cited by 6 publications

(8 citation statements)

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“…for Windows (SPSS Inc., Chicago, IL, USA 23.94 in subjects with AKI and without AKI respectively; the difference was not statistically significant. The incidences of AKI in patients with and without COPD were 16.67% (6 out of 36) and 26.03% (289 out of 1110) respectively, but the difference was not statistically significant (p:0.284).…”

Section: Meterials and Methodsmentioning

confidence: 93%

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Acute Kidney Injury (AKI) After Cardiac Surgery: Incidence, Risk Factors and Outcome

GR¹

2016

jmscr

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Section: Meterials and Methodsmentioning

confidence: 93%

“…In aggregate, however, these factors may be important and potentially modifiable. These include factors specifically related to the bypass procedure itself, such as duration of CPB [16][17][18] and on-versus offpump coronary artery bypass surgery [19][20][21][22][23][24] .…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury (AKI) After Cardiac Surgery: Incidence, Risk Factors and Outcome

GR¹

2016

jmscr

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“…Für Patienten mit einer präoperativ kompensierten Niereninsuffi-zienz ergab sich in einer Metaanalyse aus vier Beobachtungsstudien unter Einschluss von 643 Patienten kein Überlebensvorteil durch die Koronarrevaskularisation ohne die Herz-Lungen-Maschine (HLM) [38]. Zudem zeigte sich die perioperative Morbidität für niereninsuffiziente Patienten bezüglich der Schlaganfallinzidenz [5,7,56] und der Transfusionspflichtigkeit [5,49,56] signifikant reduziert. Zudem zeigte sich die perioperative Morbidität für niereninsuffiziente Patienten bezüglich der Schlaganfallinzidenz [5,7,56] und der Transfusionspflichtigkeit [5,49,56] signifikant reduziert.…”

Section: Chronisch-obstruktive Lungenerkrankung (Copd)unclassified

“…Dagegen konnte für Patienten mit dialysepflichtiger Niereninsuffizienz meist eine reduzierte peri-operative Mortalität durch die OPCAB-Chirurgie demonstriert werden [14,35,50]. In den wenigen Beobachtungsstudien an diesen Patienten wird zwar meist über eine geringere Inzidenz von postoperativem Nierenversagen bei Anwendung der OPCAB-Chirurgie berichtet [5,7,38,56], allerdings konnte dies in einer Propensity-Score-Analyse an 632 Patienten so nicht bestätigt werden [11]. Inwieweit die Wahl der OPCAB-Chirurgie bei Patienten mit präoperativ noch kompensierter Niereninsuffizienz das Auftreten eines postoperativen dialysepflichtigen Nierenversagens zu reduzieren vermag, kann anhand der derzeitigen Datenlage nicht sicher beantwortet werden.…”

Section: Chronisch-obstruktive Lungenerkrankung (Copd)unclassified

Chirurgische Koronarrevaskularisation am schlagenden Herzen

Rastan

Walther

Falk³

et al. 2007

Herz

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Since the introduction of off-pump coronary artery bypass grafting (OPCAB) for coronary multivessel disease there was growing interest to evaluate the impact of OPCAB surgery compared to conventional coronary artery bypass grafting (CCAB) with cardiopulmonary bypass and cardioplegic arrest. However, subsequent prospective randomized studies and meta-analyses comparing OPCAB and CCAB surgery were performed on low-risk patients or mixed-risk populations. They usually failed to demonstrate a significant benefit of OPCAB surgery on early mortality or perioperative major cardiac and cerebrovascular events. In recent years, efforts were made to analyze the meaning of beating-heart concepts for patients with specific cardiac and extracardiac risks like ischemic cardiomyopathy, older age, renal failure, acute coronary syndrome, left main stenosis and others. For these subsets of patients several mono- and multicenter studies are available today. Even if most of them were nonrandomized and thus failed to reach evidence level A according to the AHA/ACC (American Heart Association/American College of Cardiology) definition, they still allow analyzing interim results for each specific perioperative risk factor. Particularly multi-risk patients and patients with severely reduced left ventricular function seem to benefit in terms of perioperative mortality and major morbidity by avoiding cardiopulmonary bypass and cardioplegic arrest. Analyzing early results and long-term follow-up of 364 patients with severely reduced ejection fraction<20%, the authors found a long-term benefit for patients when using OPCAB strategies particularly due to reduced perioperative mortality. Moreover, for most subsets of patients with significant extracardiac risk factors the incidence or perioperative stroke was reduced. In patients with preoperative renal and pulmonary dysfunction a decrease of corresponding organ failure was found for OPCAB strategy. For most risk populations transfusion requirements were significantly lower in OPCAB compared to CCAB surgery. In none of the patients an unfavorable outcome of beating-heart surgery compared to CCAB was shown. For emergency patients with an acute coronary syndrome presenting stable and unstable hemodynamics the authors found a clinical benefit by using beating-heart strategies. Particularly in patients with cardiogenic shock, cardiopulmonary bypass was often required to guarantee adequate perioperative organ perfusion. However, these patients seemed to benefit from avoiding global cardiac ischemia and maintaining native coronary blood flow. Follow-up results were comparable for these patients. In conclusion, beating-heart coronary artery bypass grafting seems to be advantageous in various risk populations and should be considered for patients with more than average risks for cardiopulmonary bypass and cardioplegic arrest.

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“…• Increased age 73,75,77,80,90,96,100,101 • Left Main Disease 74,79 • Diabetes 95,103 • Renal Dysfunction 72,75,83,108 • COPD 28,36,75 Statement:…”

Section: A) Mortality In High-risk Patientsmentioning

confidence: 99%

Off-Pump versus Conventional Coronary Artery Bypass Grafting: A Meta-Analysis and Consensus Statement from the 2004 ISMICS Consensus Conference

Puskas

Cheng

Knight

et al. 2005

Innovations�(Phila)

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Background The purpose of this evidence-based consensus statement is to systematically review and meta-analyze the randomized and nonrandomized evidence comparing off-pump (OPCAB) to conventional coronary artery bypass (CCAB) surgery and to provide consensus on the role of OPCAB in low- and high-risk surgical patients. Methods and Results This consensus conference was conducted according to the American College of Cardiology (ACC)/American Heart Association (AHA) standards for development of clinical practice guidelines. The Steering Committee collated all published studies of OPCAB versus CCAB through May 2004 and developed six questions central to controversies surrounding OPCAB surgery in mortality, morbidity, and resource utilization. For mixed-risk patient populations, meta-analysis of 37 randomized clinical trials (3,369 patients, Level A) reported across a total of 53 papers, and two meta-analyses of nonrandomized trials (Level B) comparing OPCAB versus CCAB were identified. For high-risk patient populations, we performed a meta-analysis of 3 randomized and 42 nonrandomized trials (26,349 patients, Level B). Conclusion Meta-analysis of Level A and B evidence provided the basis for the following consensus statements in patients undergoing surgical myocardial revascularization: (1) OPCAB should be considered a safe alternative to CCAB with respect to risk of mortality [Class I, Level A]; (2) With appropriate use of modern stabilizers, heart positioning devices, and adequate surgeon experience, similar completeness of revascularization and graft patency can be achieved [Class IIa, Level A]; (3) OPCAB is recommended to reduce perioperative morbidity [Class I, Level A]; (4) OPCAB may be recommended to minimize midterm cognitive dysfunction [Class IIa, Level A]; (5) OPCAB should be considered as an equivalent alternative to CCAB in regard to quality of life [Class I, Level A]; (6) OPCAB is recommended to reduce the duration of ventilation, ICU and hospital stay, and resource utilization [Class I, Level A]; (7) OPCAB should be considered in high-risk patients to reduce perioperative mortality, morbidity, and resource utilization [Class IIa, Level B].

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Is Off-Pump Revascularization Better for Patients with Non-Dialysis-Dependent Renal Insufficiency?

Cited by 6 publications

References 0 publications

Acute Kidney Injury (AKI) After Cardiac Surgery: Incidence, Risk Factors and Outcome

Acute Kidney Injury (AKI) After Cardiac Surgery: Incidence, Risk Factors and Outcome

Chirurgische Koronarrevaskularisation am schlagenden Herzen

Off-Pump versus Conventional Coronary Artery Bypass Grafting: A Meta-Analysis and Consensus Statement from the 2004 ISMICS Consensus Conference

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