Robotic Beating Heart Totally Endoscopic Coronary Artery Bypass: Impact Of Chronic Kidney Disease On Post-operative Outcomes
Tatsuya Watanabe, Hiroto Kitahara, Charocka Coleman, Brooke Patel, Husam H. Balkhy.
The University of Chicago Medicine, Chicago, IL, USA.
BACKGROUND: Chronic kidney disease(CKD) is a risk factor for postoperative acute renal insufficiency(AKI) in patients undergoing coronary bypass grafting (CABG). Avoiding cardiopulmonary bypass during Off-pump CABG (OPCAB) has not mitigated this risk; possibly due to the need for vasopressors to avoid hemodynamic instability during OPCAB. In robotic beating heart totally endoscopic coronary artery bypass (TECAB), the hemodynamics during surgery are usually stable without vasopressors because this procedure does not necessitate aggressive heart displacement. Our study aims to explore the impact of different stages of CKD on the outcomes of patients undergoing robotic TECAB and specifically in regards to the development of postoperative AKI. METHODS: We retrospectively reviewed patients undergoing robotic TECAB from July 2017 to October 2021 at our institution. We compared the outcomes between patients with normal renal function, mild CKD, and moderate to severe CKD. RESULTS: A total of 351 consecutive patients undergoing robotic TECAB were retrospectively analyzed. Patients were classified based on the Kidney Disease Improving Global Outcomes 2012 clinical practice guideline (eGFR; Stage1:90-, Stage2:60-89, Stage3A:45-59, Stage3B:30-44, Stage4:15-29, Stage5:-14). Patients with hemodialysis were excluded from this study. The cohorts include the following number of patients with each stage (Stage 1, n=88; Stage 2, n=159; Stage 3A, n=46; Stage 3B, n=34, Stage 4, n=2, Stage 5, n=3). Perioperative creatinine and eGFR fluctuations with each CKD stage are shown in figure1. We divided the CKD stages into three groups: normal renal function (Stage1; n=88), mild CKD (Stage2; n=159), moderate to severe CKD (Stage3, 4 and 5; n=85). Moderate to severe CKD patients had lower preoperative hemoglobin and albumin. There were no significant differences in mortality, mean length of intensive care unit stay, postoperative hospital stay, postoperative atrial fibrillation, postoperative AKI, and transfusion rate between the 3 groups. CONCLUSIONS: Moderate to severe CKD was not associated with worse postoperative outcomes or reduction in renal function and the risk of AKI after robotic TECAB. Figure.1 Legend: A: Perioperative fluctuation of Creatinine in each CKD stage (preoperative, postoperative, and postoperative peak).B: Perioperative fluctuation of eGFR in each CKD stage (preoperative, postoperative, and postoperative nadir). 
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