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International Society For Minimally Invasive Cardiothoracic Surgery

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Progression of Renal Dysfunction After On-pump vs Off-pump Technique for Cabg
Panos Vardas, Clifton Lewis, Kyle Eudailey, Sara Pereira, James Davies
University of Alabama at Birmingham, Birmingham, AL, USA

BACKGROUND: The aim of this study was to analyze the progression of pre-existing renal dysfunction and short-term outcomes for patients undergoing isolated Off-Pump Coronary Artery Bypass (OPCAB) versus ON-pump technique (ONCAB).
METHODS: A retrospective cohort analysis of primary, non-emergent, isolated CAB surgery using the institutional STS Database from January 2013 to December 2018 identified 1,809 cases. The patients were stratified into 3 categories according to their pre-operative estimated glomerular filtration rate (eGFR) of >60, 30-60, <30 (in mL/min/1.73 m2) and OPCAB was compared to ONCAB with a 1:1 matched cohort propensity score analysis.
RESULTS: There were no differences in pre-operative characteristics. The mean age was 61.810.6 vs 62.110.5 years and females comprised 27.8 vs 25.8 % for ONCAB versus OPCAB, respectively. There was no difference for pre-operative characteristics. The ONCAB group had a higher number of revascularized vessels (3.30.9 vs 3.00.6, p <.0001) and a higher need for transfusions (33.3% vs 15.8%, p<.0001). There was a trend in the incidence of post-operative renal failure and de-novo dialysis for the OPCAB group (1.5% vs 2.5%, p-0.20 and 0.6% vs 1.9%, p-0.08 respectively). eGFR<30 mL/min/1.73 m2 was an independent predictor factor for post-operative renal failure in both groups (OR-10.7, CI-95%). Regarding the progression of renal dysfunction, there was no significant difference among the matched groups (Table 1). Specifically, for the ONCAB the progression of patients with eGFR of >60 to renal dysfunction post-operatively was 27% (2% deteriorated to eGFR<30 and 25% to eGFR 30-60), while for the OPCAB was 30% (3% to eGFR<30, 27% to eGFR 30-60, p-0.53). For patients with pre-existing renal dysfunction (eGFR 30-60), 20% vs 24% of the ONCAB and OPCAB group respectively had renal deterioration to eGFR<30 (p-0.71). CONCLUSIONS: There was no significant difference in de novo renal failure and worsening renal dysfunction with the on-pump technique for isolated CABG.


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