Beating Heart Cabg Leads To Better Outcomes For Patients With Chronic Kidney Disease
Vijit K. Cherian, Gopal Murugesan, Ravi Shivdasani, Gokulkrishnan Mohan, Rajan Ravichandran, Ganesh Prasad.
MIOT International Hospital, Chennai, India.
Introduction: In patients with chronic kidney disease (CKD), coronary artery disease (CAD) is the leading cause of death. Several retrospective studies have shown that coronary artery bypass grafting (CABG) in patients with chronic kidney disease (CKD) is associated with higher procedural mortality and postoperative morbidity but better long term survival than percutaneous coronary intervention (PCI) or medical therapy. Objective: In this study, we sought to assess the postoperative outcomes of all patients with chronic kidney disease undergoing CABG. Methods & Materials Retrospective observational study was done assessing preoperative, intraoperative and postoperative parameters of all consecutive patients with dialysis or non-dialysis dependent renal dysfunction undergoing CABG at our institute. Results: 87 consecutive patients with significant renal dysfunction were operated in a six year period with mean age 54 ± 11.6 years. Mean serum creatinine of the patients was 2.3 ± 1.2 mg/dl and mean eGFR was 33.6 ±9.4 ml/min. 78.1 % of the patients had moderate renal dysfunction and 21.8 % had severe renal dysfunction by eGFR criteria. 18.3% of patients were dialysis dependent, while 9% were post renal transplant. 54% had triple vessel disease and 38% had left main disease. 97.7% of these patients were done using the off-pump surgical techniques. In hospital mortality was 3.4% with low cardiac output being a leading cause. Newer dialysis requirement was observed in 4.5% of patients. Only 4.5 % of the patients required post-operative blood transfusion. Conclusion: Renal dysfunction patients undergoing CABG can have significantly better outcomes if preoperative assessment and preparation, intraoperative and postoperative care adhering to strict protocols by a team of cardiothoracic surgeons, anaesthetists and nephrologists is carried out. Beating heart off pump surgery helped reduce perioperative blood loss and ICU stay. The outcomes of this group of patients were significantly better compared to earlier reported series. A larger cohort of such patients needs to be evaluated to corroborate our findings.
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