Safety and Efficacy of Off‐Pump Coronary Artery Bypass Grafting in Chronic Dialysis Patients

Abstract

Off-pump coronary artery bypass grafting (CABG) has been recently revived, because cardiopulmonary bypass (CPB) appears to worsen the multiple organ dysfunction after conventional CABG. To evaluate the safety and efficacy of the off-pump CABG in chronic dialysis patients, we compared the perioperative morbidity and mortality between 15 dialysis patients who underwent off-pump CABG at our center over the past 8 years with that of a concurrent group of 19 patients who underwent conventional CABG. Patients were selected for off-pump CABG only when complete revascularization was technically feasible. We found that off-pump CABG is as safe and effective as conventional CABG in selected dialysis patients. It might even be beneficial, because it is associated with less hematocrit drop and blood product use, a lower catabolic rate, and fewer dialysis requirements after surgery. However, the impact of off-pump technique on the long-term clinical outcome and resource utilization in renal patients requires further investigation.

Management of Coronary Artery Disease in End‐Stage Renal Disease

“…OPCABG was associated with 16% reduction in all‐cause mortality in adjusted Cox models (HR 0.84; 95% CI, 0.72, 0.99; p = 0.032). Another small retrospective analysis comparing OPCABG and on‐pump CABG in dialysis patients again observed equivalent safety and efficacy of the operation with reduced transfusions and reduced postoperative dialysis need favoring OPCABG (49).…”

Hemodiafiltration During Cardiac Surgery in Patients on Chronic Hemodialysis

“…Off‐pump procedures have recently been introduced for isolated CABG in patients who are on long‐term dialysis 8‐10 . The rationale for off‐pump CABG includes the presence of abundant calcifications of the ascending aorta, or cerebrovascular lesions, or both, and the avoidance of complications associated with the use of a heart‐lung machine.…”

“…Off-pump procedures have recently been introduced for isolated CABG in patients who are on long-term dialysis. [8][9][10] The rationale for off-pump CABG includes the presence of abundant calcifications of the ascending aorta, or cerebrovascular lesions, or both, and the avoidance of complications associated with the use of a heart-lung machine. However, because relatively large amounts of fluid are needed to support the hemodynamics during rotation of the heart, hampering the control of fluids and electrolyte balance in dialysis patients, on-pump CABG with extracorporeal ultrafiltration, hemofiltration, or hemodialysis on a heart-lung machine continue to be used by many medical centers.…”

“…This higher longevity has increased the number of patients on long‐term dialysis who require cardiac surgery for conditions such as ischemic heart disease and valve calcifications. Despite the use of perioperative continuous hemodiafiltration (HDF) 7,8 and minimally invasive techniques, such as off‐pump coronary artery bypass grafting (CABG), 8‐10 the rates of perioperative complications and early mortality among patients on dialysis remain high. Major factors contributing to poor surgical outcomes include complex perioperative management and surgical procedures, and complications of cardiopulmonary bypass 11‐25 .…”

Effects of cardiopulmonary bypass on dialysisdependent patients

“…3 Off-pump coronary artery bypass grafting (OPCAB) is a wellestablished and feasible procedure with reduced morbidity and mortality rates in high-risk patients. 4,5 By contrast, some authors reported that long-term survival rates after OPCAB were worse than those of on-pump coronary artery bypass grafting (ONCAB) because of lower rates of complete revascularisation. 6 However, it was reported that OPCAB had better short-term outcomes than conventional CABG in ESRD patients.…”