On pump versus off pump coronary revascularisation: evaluation of renal function

R Ascione, CT Lloyd, MJ Underwood, WJ Gomes, GD Angelini

Research output: Contribution to journalArticle (Academic Journal)

351 Citations (Scopus)

Abstract

BACKGROUND:

Coronary revascularization with cardiopulmonary bypass has the potential risk of renal dysfunction related to the nonphysiologic nature of cardiopulmonary bypass. Recently, there has been a revival of interest in performing myocardial revascularization on the beating heart and we investigated whether this prevents renal compromise.

METHODS:

A prospective, randomized, controlled trial was performed in 50 patients (45 males, mean age 61+/-3.7 years) undergoing elective coronary artery bypass grafting. Patients were randomly assigned to conventional revascularization with cardiopulmonary bypass (on pump) or beating heart revascularization (off pump). Glomerular and tubular function were assessed up to 48 hours postoperatively.

RESULTS:

There were no deaths, myocardial infarctions or acute renal failure in either group. Glomerular filtration as assessed by creatinine clearance and the urinary microalbumin/creatinine ratio was significantly worse in the on pump group (p < 0.0004 and 0.0083, respectively). Renal tubular function was also impaired in the on pump group as assessed by increased N-acetyl glucosaminidase activity (p < 0.0272).

CONCLUSIONS:

These results suggest that off pump coronary revascularization offers a superior renal protection when compared with conventional coronary revascularization with cardiopulmonary bypass and cardioplegic arrest in first time coronary bypass patients.
Original languageEnglish
Pages (from-to)493 - 498
Number of pages5
JournalAnnals of Thoracic Surgery
Volume68
Issue number2
DOIs
Publication statusPublished - Aug 1999

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