|Title:||Late dialysis rate for coronary artery bypass grafting patients with moderate-to-severe renal impairment: comparison between off-pump and conventional method||Authors:||Yu H.-Y.
|Issue Date:||2008||Journal Volume:||33||Journal Issue:||3||Start page/Pages:||364-369||Source:||European Journal of Cardio-thoracic Surgery||Abstract:||
Background: Whether off-pump coronary artery bypass grafting has a late renal protective advantage over conventional coronary arterial bypass grafting with cardiopulmonary bypass use is controversial. Methods: From 1997 to 2004, 2102 cases of isolated coronary arterial bypass grafting were collected and analyzed, 1116 (53%) in the cardiopulmonary bypass group and 986 (47%) in the off-pump coronary artery bypass grafting group. Cases were stratified by preoperative estimated glomerular filtration rate into three renal groups: 1012 (48%) in group 1, with glomerular filtration rates ?60 ml/h, 864 (41%) in group 2, with glomerular filtration rates of 30-60 ml/h, and 226 (10.8%) in group 3, with glomerular filtration rates <30 ml/h, but without dialysis before surgery. Results: The in-hospital mechanical renal replacement therapy rates were 2.0%, 4.6%, and 26.1%, respectively, for the three renal groups that underwent coronary artery bypass grafting with conventional cardiopulmonary bypass, and 1.1%, 3.4%, and 14.0%, respectively for the three renal groups that underwent off-pump coronary artery bypass grafting. After risk adjustment, cardiopulmonary bypass use did not show statistical significance for in-hospital mechanical renal replacement therapy (p = 0.314, 0.524, 0.150, respectively, across renal groups 1-3). At the end of the 4-year follow-up period, 99.1%, 97.2%, and 78.6%, respectively, of patients were free of mechanical renal replacement therapy across the three renal groups (p = 0.0097 between renal groups 1 and 2; p < 0.001 between renal groups 2 and 3). Cox regression analysis for renal groups 2 and 3 revealed that cardiopulmonary bypass use was not a risk factor for mid-term mechanical renal replacement therapy (p = 0.452), but preoperative glomerular filtration rate, hypercholesterolemia, insulin-requiring diabetes, young age at surgery, female gender, and in-hospital mechanical renal replacement therapy use were. Conclusion: Patient characteristics, rather than operative strategy of using off-pump or conventional coronary artery bypass grafting, influence the mid-term mechanical renal replacement therapy rate for patients with glomerular filtration rates <60 ml/min. ? 2008 European Association for Cardio-Thoracic Surgery.
|ISSN:||1010-7940||DOI:||10.1016/j.ejcts.2007.12.027||metadata.dc.subject.other:||adult; aged; article; controlled study; conventional coronary artery bypass grafting; coronary artery bypass graft; diabetes mellitus; female; glomerulus filtration rate; human; hypercholesterolemia; intermethod comparison; kidney dysfunction; major clinical study; male; off pump coronary surgery; preoperative care; priority journal; renal replacement therapy; risk assessment; sex difference; Aged; Cardiopulmonary Bypass; Coronary Artery Bypass; Coronary Artery Bypass, Off-Pump; Female; Follow-Up Studies; Glomerular Filtration Rate; Hemofiltration; Humans; Kidney Failure; Male; Middle Aged; Postoperative Complications; Regression Analysis; Risk Factors
|Appears in Collections:||醫學系|
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