ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Is off-pump coronary bypass a good choice in patients with chronic renal failure?
Vedat Erentuğ, Hasan Basri Erdoğan, Nihan Kayalar, Adil Polat, Başar Sareyyüboğlu, Kaan Kırali, Esat Akıncı, Cevat Yakut
Department of Cardiovascular Surgery, Kartal Koşuyolu Heart and Research Hospital, İstanbul
Background: Patients with chronic renal disease who underwent coronary artery bypass grafting were studied and perioperative and postoperative results were analyzed.

Methods: Thirty one patients (23 males, 8 females; mean age 62.45±9.34 years; range 41-75) with known chronic renal disease were operated for coronary artery disease in our clinics. Eleven patients were dialysis-dependent preoperatively. Mean preoperative creatinine value was 5.88±2.84 mg/dl in dialysis-dependent patients and 2.4±1.4 mg/dl in non-dialysis dependent patients. We performed on-pump coronary artery bypass surgery in 18 patients whereas 13 patients underwent coronary artery bypass grafting with off-pump technique. Mean number of grafts was 2.8±0.9 in patients operated on with cardiopulmonary bypass and 1.6±0.7 in patients operated on with off-pump technique. Complete revascularisation was accomplished in 77.7% of the former group whereas in 76.9% in the latter group. We analyzed both groups in regards to postoperative complications, mortality/morbidity and duration of intensive care unit and hospital stay.

Results: Early mortality rate was 9.6% (3 patients). Myocardial infarction developed in 2 patients during perioperative period and intraaortic balloon pump counterpulsation was performed. Postoperative complications such as sternal dehiscence, infection and neurological complications during early postoperative period were observed more frequently in patients undergoing cardiopulmonary bypass (p=0.02). There was no signficant difference between the two groups with respect to mortality, arrhythmia, perioperative myocardial infarction and drainage amount. Mean duration of intubation, hospital stay and intensive care unit stay were shorter in the off-pump group, although not statistically significant.

Conclusion: Patients with dialysis-dependent chronic renal failure who present with coronary artery disease should be thoroughly evaluated preoperatively for risk factors and coexistent severe diseases. We believe that in patients with chronic renal failure, off-pump coronary revascularization is a good alternative.

Keywords : Cardiac surgical procedures/adverse effects; intraoperative complications; kidney failure, chronic/complications; postoperative complications
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