Contents
Download PDF
pdf Download XML
20 Views
4 Downloads
Share this article
Research Article | Volume 15 Issue 1 (Jan - Feb, 2025) | Pages 143 - 149
Preoperative Mild Renal Dysfunction on Outcomes Following Off-Pump Coronary Artery Bypass Grafting in Comparison with Normal Renal Function
 ,
 ,
 ,
1
Associate consultant, Department of Cardiothoracic and vascular surgery, Yashoda Hospital, Secunderabad.
2
Senior consultant, Head of the Department, Cardiothoracic and Vascular Surgery, Yashoda Hospital, Secunderabad.
3
Consultant, Department of Cardiovascular and Thoracic surgery, KIMS Hospital, Srikakulam, Andhrapradesh
4
Associate Consultant, Department of Cardiothoracic and vascular surgery, Yashoda Hospital, Malakpet
Under a Creative Commons license
Open Access
Received
Nov. 20, 2024
Revised
Dec. 3, 2024
Accepted
Dec. 24, 2024
Published
Jan. 14, 2025
Abstract

Introduction Coronary artery bypass grafting (CABG) is a highly successful surgical treatment for the relief of angina and prolongs life in patients with coronary artery disease (CAD). Preoperative renal dysfunction is a significant risk factor that influences the outcome in patients undergoing CABG surgery. Mild renal dysfunction is an adverse prognostic indicator in patients with coronary artery disease. Several studies showed that patients with mild renal dysfunction have an increased risk of dying within 30 days after coronary surgery. Patients with renal dysfunction who require CABG represent a complex group of patients with accelerated atherosclerosis and advanced cardiovascular disease. Methods And Materials This is a prospective study was conducted in the Department of Cardiothoracic and vascular surgery, Yashoda Hospital, Secunderabad. OPCAB was performed with the Octopus-Evolution tissue stabilizer system device for target coronary artery stabilization. A mean systemic arterial pressure was maintained around 65 to 70 mmHg throughout the procedure. An intracoronary shunt  was used in all target coronaries greater than 1.25mm in diameter during construction of distal anastomosis. Humidified carbon dioxide blower /mister was used to disperse the blood from the anastomotic site while constructing the distal anastomoses Results The mean age in mild group was 59.05±7.60 and 56.37±9.06 in normal group, p=0.15. In mild group 16 (40.00) were females and 24 (60.00) were males whereas 10(25.00) were females and 30 (75.00) were males in normal group, p=0.15(figure 2). Preoperative variables such as BMI>30 (p=0.30), Smoking (p=1.00), Hypertension (p=0.33), Diabetes mellitus (p=0.57), Hyperlipidaemia (p=0.63), COPD (p=0.80), preoperative MI (p=0.81) were compared between the mild and normal groups and none of the baseline variables were significant between the groups Conclusions There was no significant difference in the patients undergoing off-pump CABG with normal renal function and mild renal dysfunction in terms of short-term mortality, myocardial infarction, stroke, or renal failure requiring dialysis. Off-pump CABG is more reno-protective for patients with normal renal function but for patients with mild renal dysfunction may need preoperative assessment of renal function by GFR in addition to serum creatinine levels to stratify the risk for postoperative renal dysfunction and to optimize measures for renal preservation during surgical myocardial revascularization

Keywords
INTRODUCTION

Coronary artery bypass grafting (CABG) is a highly successful surgical treatment for the relief of angina and prolongs life in patients with coronary artery disease (CAD). Preoperative renal dysfunction is a significant risk factor that influences the outcome in patients undergoing CABG surgery [1-4].


Mild renal dysfunction is an adverse prognostic indicator in patients with coronary artery disease [5]. Several studies showed that patients with mild renal dysfunction have an increased risk of dying within 30 days after coronary surgery [6,7,8]. Patients with renal dysfunction who require CABG represent a complex group of patients with accelerated atherosclerosis and advanced cardiovascular disease [9-11].


Patients with decreased renal function (serum creatinine ≥2.0 mg/dL) carry significant operative risks, require prolonged hospital stays, and have a higher risk of dying within 3 years after coronary surgery [8]. In addition, severe preoperative renal disease is associated with a higher incidence of morbidity, need for dialysis, and length of hospital stay after CABG [12].


Coronary artery bypass grafting performed with the aid of cardiopulmonary bypass adversely affects renal function, causing varying degrees of post-operative renal impairment. Off-pump coronary artery bypass grafting (OPCAB), eliminates the need for cardiopulmonary bypass (CPB), has been reported to be associated with better outcomes and is expected to have less negative impact on the postoperative renal function than conventional CABG in patients with renal dysfunction [12–15]. Though off-pump coronary artery bypass surgery technique avoids cardiopulmonary bypass circuit induced adverse effects on renal function, multiple other factors cause postoperative renal dysfunction in these group of patients.


Elevated preoperative serum creatinine (SCr) is considered an independent risk factor for postoperative morbidity and mortality in patients undergoing cardiac surgery [16,17,18]. The overall mortality for the patients with preoperative serum creatinine more than 1.5mg/dL, ranges from 5%-30% with the rise in the probability of death [17-20]. So, it is crucial to accurately assess the preoperative renal function.


Report from the Society of Thoracic Surgeons National Database on patients undergoing CABG showed that preoperative renal disease is common in patients undergoing CABG and that early mortality and morbidity after CABG rise inversely with declining preoperative renal function. Preoperative renal dysfunction is thus a powerful, independent predictor of postoperative acute kidney injury. Hence, the assessment of preoperative renal function should be incorporated into clinical risk assessment and prediction models. Furthermore, the EUROSCORE II includes renal impairment, as measured by creatinine clearance, as one of the risk factors for adverse outcomes after surgery. [21]

MATERIALS AND METHODS

This is a prospective and randomized study was conducted in the Department of Cardiothoracic and vascular surgery, Yashoda Hospital, Secunderabad.

Study sample Inclusion criteria

  1. Patient age 21-70 years old
  2. Normal preoperative renal function and preoperative mild renal dysfunction (GFR 60-90 ml/min/1.73 m2)
  3. Patients undergoing primary elective Off- pump CABG
  4. LVEF>30%
  5. Patients who are willing to give consent

 

Exclusion criteria

  1. Emergency operation
  2. Concomitant cardiac procedures with CABG
  3. Operation which was carried out via an incision other than median (e.g. anterolateral left thoracotomy)
  4. On-pump CABG
  5. Known contraindication to off-pump CABG (e.g. calcified aorta, calcified coronaries and small target vessels)
  6. LVEF<30%
  7. CVA (Recent CVA < 3 months) with or without residual neurological deficit
  8. Patients who are not willing to give consent

 

Off- pump CABG technique (OPCAB)

OPCAB was performed with the Octopus-Evolution tissue stabilizer system device (MEDTRONIC, Cardiovascular, Minneapolis, Minnesota, US) for target coronary artery stabilization. A mean systemic arterial pressure was maintained around 65 to 70 mmHg throughout the procedure. An intracoronary shunt (Medtronic, Inc, Minneapolis, MN, USA) was used in all target coronaries greater than 1.25mm in diameter during construction of distal anastomosis. Humidified carbon dioxide blower /mister (Medtronic, Inc, Grand Rapids, MI) was used to disperse the blood from the anastomotic site while constructing the distal anastomoses

 

Data collection and definitions

Demographic and procedural data will be collected from patients who are willing to take part in the study. At the time of admission to the operation baseline clinical characteristics such as age, sex, obesity, smoking, New York Heart Association (NYHA) class, previous myocardial infarction (MI), percutaneous coronary intervention (PCI), diabetes mellitus (DM), hypertension, hyperlipidaemia, chronic obstructive pulmonary disease (COPD), Left ventricular ejection fraction (LVEF), prior CVA , eGFR, anatomical severity of coronary artery disease (CAD). Operative data like number of grafts, type of conduit, target artery and postoperative details such as major adverse cardiac cerebrovascular events were collected.

 

Definitions

The serum creatinine was measured before surgery and the GFR was calculated by using Cockcroft- Gault formula [6]. Normal renal function was defined as eGFR of 90 ml/min/1.73 m2 or more and mild RI was defined as eGFR of 60 to 89 ml/min/1.73 m2.

 

Estimation of GFR by MDRD Equation

With reference to Clinical Practice Guidelines of National Kidney Foundation, normal renal function was defined as eGFR of 90 ml/min/1.73 m2 or more, and mild, moderate and severe renal insufficiency were defined as eGFR of 60 to 89, 30 to 59, and less than 30 ml/min/ 1.73 m2, respectively. This study focused on patients with mild preoperative renal insufficiency (eGFR of 60–89 ml/ min/1.73 m2) and patients with normal preoperative renal function (eGFR of 90 ml/min/1.73 m2 or more).

 

Surgical mortality was defined as death occurring during the same hospitalization or within 30 days of the operation. Postoperative myocardial infarction was defined by either the appearance of new Q waves in 2 or more contiguous leads on the electrocardiogram or an increase in the creatinine kinase MB isoenzyme fraction of more than 50U, in concert with an excess of 7% of the total creatinine kinase level. After OPCAB surgery, any episode of atrial fibrillation that was registered by the monitoring system on a rhythm strip or the 12-lead ECG and lasting for more than 5 min with or without symptoms, was defined as postoperative atrial fibrillation.

 

Intra-aortic balloon pump (IABP) support, postoperative respiratory failure (duration of mechanical ventilation more than 72 h or re-intubation following OPCAB surgery), postoperative pneumonia (a positive result in a sputum culture requiring anti-infective treatment, or chest X-ray diagnosis of pneumonia following cardiac surgery), stroke (new permanent neurological event; early stroke: within 24 h and delayed stroke greater than 24 h postoperatively), redo for bleeding (re-operation to control bleeding within 36 h following initial surgery), red blood cell (RBC) transfusion, acute kidney injury requiring dialysis, and deep sternal wound infection (DSWI) (bone related; any drainage of purulent material from the sternotomy wound and instability of the sternum) will be recorded

 

Statistical methods

Data will be presented as absolute numbers, mean, and standard deviation, or percentages. Values of continuous variables will be expressed as a mean ± standard deviation (SD). Categorical variables are represented as frequency distributions and single percentages. Normally distributed continuous variables will be compared using a student t-test, non-normally distributed continuous variables using the Mann-Whitney U test, and categorical variables will be compared by χ2 and Fisher's exact test where appropriate. Estimations of risk and potential independent predictors of outcome will be identified by logistic regression analyses. All statistical tests will be two-sided. Results will be considered statistically significant at a level of p less than 0.05. All analysis will be performed using SAS version 9.2 (SAS institute, Cary, NC) software

RESULTS

Of 80 patients, 40 patients had normal renal function and 40 patents had preoperative mild renal dysfunction

 

Analysis of baseline characteristics between mild and normal groups

 The mean age in mild group was 59.05±7.60 and 56.37±9.06 in normal group, p=0.15. In mild group 16 (40.00) were females and 24 (60.00) were males whereas 10(25.00) were females and 30 (75.00) were males in normal group, p=0.15(figure 2). Preoperative variables such as BMI>30 (p=0.30), Smoking (p=1.00), Hypertension (p=0.33), Diabetes mellitus (p=0.57), Hyperlipidaemia (p=0.63), COPD (p=0.80), preoperative MI (p=0.81) were compared between the mild and normal groups and none of the baseline variables were significant between the groups (table 1).

 

Table 1: Baseline characteristics between mild and normal groups

Variable

Unit

Mild (n=40)

Normal(n=40)

p value

Age

mean±SD

59.05±7.60

56.37±9.06

0.15

Sex

Female

16 (40.00)

10(25.00)

0.15

Male

24(60.00)

30(75.00)

BMI>30

No

28(70.00)

32(82.00)

0.30

Yes

12(30.00)

8(20.00)

Smoking

No

22(55.00)

22(55.00)

1.00

Yes

18(45.00)

18(45.00)

Hypertension

No

11(27.50)

15(37.00)

0.33

Yes

29(72.50)

25(62.50)

Diabetes mellitus

No

7(17.50)

9(22.50)

0.57

Yes

33(82.50)

31(77.50)

Hyperlipidemia

No

26(62.00)

28(70.00)

0.63

Yes

14(35.00)

12(30.00)

COPD

No

28(70.00)

29(72.50)

0.80

Yes

12(30.00)

11(27.50)

 

NYHA

1

2(5.00)

4(10.00)

0.51

2

34(85.00)

34(85.00)

3

4(10.00)

2(5.00)

NYHA

mean±SD

2.05±0.38

1.95±0.38

0.10

Preoperative CVA

No

40(100.00)

40(100.00)

-

Yes

0(0.00)

0(0.00)

Preoperative MI

No

16(40.00)

15(37.50)

0.81

Yes

24(60.00)

25(62.50)

Prior PTCA

No

29(72.50)

30(75.00)

0.79

Yes

11(27.50)

10(25.00)

LV dysfunction

No

0(0.00)

0(0.00)

-

Yes

40(100.00)

40(100.00)

 

Extent of CAD

SVD

0(0.00)

1(2.50)

0.12

DVD

0(0.00)

3(7.50)

TVD

40(100.00)

36(90.00)

Surgery

Elective

40(100.00)

40(100.00)

-

COPD: chronic obstructive pulmonary disease; NYHA: New York heart association; CVA: cerebrovascular accident; MI: myocardial infarction; PTCA: percutaneous transluminal coronary angioplasty; LV: left ventricle; SVD: single vessel disease; DVD: double vessel disease; TVD: triple vessel disease

 

Intraoperative and postoperative characteristics

Distribution of various territories and conduits shown in figure 3 and figure 4. Mean number of grafts were equal between the groups (mild 3.5±0.90 vs 3.57±0.95), p=0.72. means of ventilation requirement 12.17±9.32 was slightly high in mild group compared to means of normal group 11.9±12.01 but did not show any significance between the groups (p=0.90). Highly significant difference was observed in terms of chest drain between the groups (p=<.0001). Higher amounts of drain was observed in mild group 561.75±276.02 compared to normal group 336.25±129.11. IABP usage was observed more in mild group 6 patients (15.00%) where as it was used in 3 patients in normal group (7.50%), p=0.28 (Table 2).

 

Table 2: Intraoperative and postoperative characteristics

Variable

Unit

Mild (n=40)

Normal(n=40)

P value

 

Type of territories

LAD

0(0.00)

1(2.50)

 

 

0.46

LAD, LCx

5(12.50)

3(7.50)

LAD, LCx, RCA

28(70.00)

32(80.00)

LAD, RCA

7(17.50)

4(10.00)

Type of conduit

LIMA

0(0.00)

1(2.50)

 

0.57

LIMA+SVG

34(85.00)

34(85.00)

SVG

6(15.00)

5(12.50)

Number of

grafts

mean±SD

3.5±0.90

3.57±0.95

0.72

 

Ventilation

mean±SD

12.17±9.32

11.9±12.01

0.90

Chest drain

mean±SD

561.75±276.02

336.25±129.11

<.0001

IABP

No

34(85.00)

37(92.50)

0.28

Yes

6(15.00)

3(7.50)

 

LAD: left anterior descending artery; LCx: left circumflex artery; RCA: right coronary artery; LIMA: left internal mammary artery; SVG: saphenous vein graft, IABP: intra- aortic balloon pump

 

Postoperative outcomes

Postoperative outcomes were recorded and the outcomes were similar between the groups. One mortality (2.50%) occurred in mild group and none in normal group (p=0.31). In mild group postoperative renal dysfunction was observed in 2 patients (5.00%) and none in normal group, (p=0.15). Even though the difference between the groups is not statistically significant, postoperative CVA (p=0.61), postoperative MI (p=1.00), deep sternal wound infection (p=0.53) and means of ICU stay (p=0.72) were more in mild group compared to normal group. Means of hospital stay showed slightly high values in mild group 9.22±5.19 versus normal group 7.37±3.39, (p=0.06) and showed an inclining trend towards mild group (Table 3 & Table 4).

 

Table 3: Postoperative outcomes

Variable

Unit

Mild (n=40)

Normal(n=40)

P value

GI complications

No

38(95.00)

39(97.50)

0.55

Yes

2(5.00)

1(2.50)

Pulmonary

complications

No

27(67.50)

31(77.50)

0.31

Yes

13(32.50)

9(22.50)

LCOS

No

28(70.00)

34(85.00)

 

 

Yes

12(30.00)

6(15.00)

0.10

Postoperative AF

No

29(72.50)

35(87.50)

0.09

 

Yes

11(27.50)

5(12.50)

 

Postoperative

renal dysfunction

No

38(95.00)

40(100.00)

0.15

 

Yes

2(5.00)

0(0.00)

 

DSWI

No

33(82.50)

35(87.50)

0.53

 

Yes

7(17.50)

5(12.50)

 

ICU stay

mean±SD

3.62±1.70

3.57±0.95

0.72

Hospital stay

mean±SD

9.22±5.19

7.37±3.39

0.06

GI: gastrointestinal; LCOS: low cardiac output syndrome; AF: atrial fibrillation; DSWI: deep sternal wound infection, ICU: intensive care unit;

 

Table 4: Postoperative MACCE

Variable

Unit

Mild (n=40)

Normal(n=40)

P value

Postoperative MI

No

38(95.00)

38(95.00)

1.00

Yes

2(5.00)

2(5.00)

Mortality

No

39(97.50)

40(100.00)

0.31

Yes

1(2.50)

0(000)

CVA

No

37(92.50)

39(97.50)

0.61

Yes

3(7.50)

1(2.50)

Re-exploration

No

34(85.00)

36(90.00)

0.49

Yes

6(15.00)

4(10.00)

MACCE: major adverse cardiac and cerebrovascular events; MI: myocardial infarction CVA: cerebrovascular accident

 

Table 5. Analysis of Maximum Likelihood Estimates effecting hospital stay with in-hospital variables

 

Estimate

Standard error

Odds ratio

95% Confidence interval

p value

Number of grafts

0.026

0.72

1.027

0.24

4.25

0.97

Chest drain

0.0058

0.004

1.006

0.99

1.01

0.21

Sr CrDay-1

-10.99

3.51

<0.001

<0.001

0.01

0.001

GFR Day-1

-0.21

0.08

0.804

0.68

0.94

0.007

Sr Cr Day-5

-368

6.55

0.025

<0.001

>999.9

0.57

GFR Day -5

-0.22

0.11

0.801

0.64

0.99

0.04

Ventilation

-032

0.21

0.724

0.47

1.11

0.14

IABP usage

-1.76

3.09

0.029

<0.001

>999.9

0.56

Low cardiac output syndrome

-0.51

1.65

0.355

<0.001

237.66

0.75

Postoperative atrial fibrillation

-1.74

1.57

0.03

<0.001

14.71

0.26

Postoperative Renal dysfunction

-8.74

223.8

<0.001

<0.001

>999.9

0.96

Re-exploration

1.62

3.81

25.98

<0.001

>999.9

0.66

Deep sternal wound infection

-0.52

0.35

0.35

0.004

32.13

0.64

DISCUSSION

Preoperative renal dysfunction has been designated as an important risk factor for postoperative outcomes in isolated CABG. Mild renal dysfunction is associated with higher incidence of major adverse cardiovascular and cerebral event (MACCE) as compared to normal population undergoing CABG

 

The strong association between renal function and outcome after cardiac surgery has been demonstrated in previous studies. Durmaz et al. [22] reported increased in-hospital mortality rates of 11.8%, 33.0% and 12.5% in patients who had creatinine levels between

1.6 and 2.5 mg/dl, 2.5 mg/dl and end-stage renal disease on haemodialysis, respectively.

 

Weerasinghe et al. [20] demonstrated that a mild elevation (1.31–1.5 mg/dl) in preoperative serum creatinine level significantly increased the need for renal replacement therapy, the duration of special care, total postoperative stay and in-hospital mortality. In alignment with previous studies the current study also demonstrated increased hospital mortality, postoperative stay in mild renal dysfunction group with rise in serum creatinine levels on 5th postoperative day.

 

Various studies have determined the comparison between normal and mild renal dysfunction. Hirose et al studied 1725 patients undergoing CABG and concluded that mild renal dysfunction was associated with prolonged postoperative course and higher incidence of major complications (28.8% vs 10.7%; p< 0.001) and mortalities (6.8% vs 0.5%; p< 0.0005) [8]. Zaker and colleagues [1] studied 4403 patients undergoing primary isolated CABG with baseline serum creatinine greater than 200umol/l and found significant in hospital mortality (2.1% vs. 6.1%; p< 0.001), new dialysis (0.8% vs 5.2%; p< 0.001), arrhythmias (29% vs 39%) among the mild renal dysfunction group. Current study is in concurrence with these studies where the major adverse cardiac and cerebrovascular events are associated in patients with mild renal dysfunction.

 

Ueki and colleagues [23] filtration rate (eGFR). The clinical outcomes were compared between patients undergoing off-pump (n= 23,634) and on-pump CABG in each stratum. The study demonstrated that in patients with mildly reduced renal function (eGFR of 60- 89 mL/min/1.73 m2), there was no significant risk reduction effect of off-pump CABG for operative mortality. Conversely, in patients with moderate or severe renal disease (eGFR of<60 mL/min/1.73 m 2), off-pump CABG was associated with a significantly lower incidence of operative death. In addition, in patients with severe renal disease (eGFR of <30 mL/min/1.73 m2), off-pump CABG was associated with a significantly lower incidence of de novo dialysis.

 

Ueki and colleagues concluded that off-pump CABG significantly reduced operative mortality in patients with moderate or severe preoperative renal dysfunction but not in those with mild preoperative renal dysfunction. The present study was conducted in patients who underwent only off-pump CABG and compared mild preoperative renal dysfunction with and normal renal function. Even though the current study was not in alignment with the study design of Ueki et al, the results of this study are similar in terms of less outcomes postoperatively may be due to usage of off- pump CABG technique.

 

Prolonged mechanical ventilation and greater risk of reintubation in patients with renal dysfunction are attributed to impaired ability of the kidneys to eliminate fluid from the interstitium thereby predisposing these patients to fluid retention and excessive lung water. Studies have shown that a need for more than 48hrs ventilation and reintubation is higher in patients with significant renal dysfunction undergoing CABG relative to those with normal or mild renal [24] dysfunction. The authors [25] found greater requirement for ventilation in their study.

 

Charitan et al showed progressive increase in ventilation duration in the patients with various stages of CKD [26]. In concurrence with these authors the current study also showed slightly high requirement of ventilation in mild group compared to normal group.

 

Incidence of post-operative atrial fibrillation (AF) has been seen to increase with progression of CKD. The mechanism behind the myocardial electrical disturbance can be attributed to electrolyte imbalance frequently observed in this subset of patients when compared to patients with normal renal function undergoing CABG. The high incidence of stroke in CKD patients has been shown by studies in plenty [27]. Similarly increase in incidence of postoperative AF and CVA was observed in this study.

CONCLUSION

There was no significant difference in the patients undergoing off-pump CABG with normal renal function and mild renal dysfunction in terms of short-term mortality, myocardial infarction, stroke, or renal failure requiring dialysis. Off-pump CABG is more reno-protective for patients with normal renal function but for patients with mild renal dysfunction may need preoperative assessment of renal function by GFR in addition to serum creatinine levels to stratify the risk for postoperative renal dysfunction and to optimize measures for renal preservation during surgical myocardial revascularization.

REFERENCES
  1. Zakeri R, Freemantle N, Barnett V, et Relation between mild renal dysfunction and outcomes after coronary artery bypass grafting. Circulation. 2005;112(9 Suppl): I270-5.
  2. Vohra HA, Armstrong LA, Modi A, Barlow Outcomes following cardiac surgery in patients with preoperative renal dialysis. Interact Cardiovasc Thorac Surg. 2014; 18:103–11.
  3. Domoto S, Tagusari O, Nakamura Y, et Preoperative estimated glomerular filtration rate as a significant predictor of long-term outcomes after coronary artery bypass grafting in Japanese patients. Gen Thorac Cardiovasc Surg. 2014; 62:95–102.
  4. Marui A, Okabayashi H, Komiya T, et al. Impact of occult renal impairment on early and late outcomes following coronary artery bypass Interact Cardiovasc Thorac Surg. 2013; 17:638–43.
  5. Anevakar NS, McMurray JJV, Velasquez EJ, et Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med. 2004;351:1285– 1295
  6. Anderson RJ, O’brien M, MaWhinney S, et al. Renal failure predisposes patients to adverse outcome after coronary artery bypass VA Cooperative Study #5. Kidney Int. 1999; 55:1057-62
  7. Nakayama Y, Sakata R, Ura M, Itoh T. Long-term results of coronary artery bypass grafting in patients with renal insufficiency. Ann Thorac Surg. 2003; 75:496-500
  8. Hirose H, Amano A, Takahashi A, Nagano N. Coronary artery bypass grafting for patients with non-dialysis-dependent renal dysfunction (serum creatinine > or =2.0 mg/dl). Eur J Cardiothorac Surg. 2001; 20:565-72
  9. Liu JY, Birkmeyer JO, Sanders JH, et al. Risks of morbidity and mortality in dialysis patients undergoing coronary artery bypass surgery. Circulation 2000; 102:2973–7.
  10. Reddan DN, Szczech L, Tuttle RH, et al. Chronic kidney disease, mortality and treatment strategies among patients with clinically significant coronary artery disease. J Am Soc Nephrol 2003; 14:2373– 80.
  11. Szczech LA, Reddan DN, Owen WF, et al. Differential survival following coronary revascularization procedures among patients with renal insufficiency. Kidney Int 2001;60: 292–9.
  12. Sajja LR, Mannam G, Chakravarthi RM, Guttikonda J, Sompalli S, Bloomstone J. Impact of preoperative renal dysfunction on outcomes of off-pump coronary artery bypass grafting. Ann Thorac Surg. 2011; 92:2161-7
  13. Cooper WA, O’Brien SM, Thourani VH, et al. Impact of renal dysfunction on outcomes of coronary artery bypass surgery: Results from the Society of Thoracic Surgeons National Adult Cardiac Database. Circulation 2006; 113:1063–70.
  14. Massoudy P, Wagner S, Thielmann M, et Coronary artery bypass surgery and acute kidney injury: impact of the off-pump technique. Nephrol Dial Transplant 2008; 23:28530.
  15. Seabra VF, Alobaidi S, Balk EM, Poon AH, Jaber BL. Off-pump coronary artery bypass surgery and acute kidney injury: a meta-analysis of randomized controlled Clin J Am Soc Nephrol. 2010; 5:1734–44.
  16. Roques F, Nashef SAM, Micheal P, et al. Risk factors and outcome in European cardiac surgery: analysis of the Euro- SCORE multinational database of 19030 patients. Eur J Cardiothorac Surg.1999; 15:816-23
  17. Lok CE, Austin PC, Wang H, Tu Impact of renal insufficiency on short- and long- term outcomes after cardiac surgery. Am Heart J. 2004; 148:430-8.
  18. Devbhandari MP, Duncan AJ, Grayson AD, Fabri BM, Keenan DJM,Bridgewater B, et al., On the behalf of the North West quality improvement programme in cardiac interventions. Effect of risk-adjusted, non-dialysis dependent renal dysfunction on mortality and morbidity following coronary artery bypass surgery: a multicenter study. Eur J Cardiothorac Surg. 2006; 29:964-70.
  19. Wang F, Dupuis JY, Nathan H, Williams K. An analysis of the association between preoperative renal dysfunction and outcome in cardiac surgery. Estimated creatinine clearance or plasma creatinine level as measures of renal function. Chest. 2003; 124:1852-62
  20. Weerasinghe A, Hornick P, Smith P, Taylor K, Ratnatunga Coronary artery bypass grafting in non-dialysis dependent mild to moderate renal dysfunction. JThoracCardiovasc Surg. 2001; 121:1083-9.
  21. org. euroSCORE: European System for Cardiac Operative Risk Evaluation. Available at: www.euroscore.org. Accessed March 23, 2018.
  22. Zhang Q, Ma CS, Nie SP, et al. Prevalence and impact of renal insufficiency on clinical outcomes of patients undergoing coronary revascularization. Circ J. 2007; 71:1299–304.
  23. Hitoshi H, Atushi A, Akihito T, Nagano N. Coronary artery bypass grafting for patients with non-dialysis-dependent renal dysfunction (serum creatinine 0 mg/dl). Eur J Cardiothorac Surg 2001; 20:565–72.
  24. Ferguson TB Jr, Dziuban SW Jr, Edwards FH, et al. The STS National Database: current changes and challenges for the new millennium. Ann Thorac Surg 2000; 69:680 –91.
  25. Rao V, Weisel RD, Buth KJ, et al. Coronary artery bypass grafting in patients with non-dialysis-dependent renal insufficiency. Circulation 1997;96(suppl II): II-38 – 45.
  26. Sajja LR, Mannam G, Chakravarthy RM, et Coronary artery bypass grafting with or without cardiopulmonary bypass in patients with preoperative non-dialysis dependent renal insufficiency: a randomized study. J Thorac Cardiovasc Surg 2007; 133:378 – 88.
  27. National Kidney Foundation. Kidney Disease Outcome Quality Initiative (K/DOQI) clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis. 2002;39: S1-266
Recommended Articles
Research Article
Surgical Management and Outcomes of Carotid Body Tumors: A Retrospective Analysis and Training Perspective.
Published: 14/01/2025
Download PDF
Chat on WhatsApp
Copyright © EJCM Publisher. All Rights Reserved.