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Emil P Paganini - One of the best experts on this subject based on the ideXlab platform.
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effect of off Pump coronary artery bypass graft Surgery on postoperative acute kidney injury and mortality
Critical Care Medicine, 2006Co-Authors: Charuhas V Thakar, Ethan Katz, Jean Pierre Yared, Joseph Sabik, Emil P PaganiniAbstract:Objective: Risk of mortality after cardiac Surgery is associated with severity of acute kidney injury. The aim of this study is to examine the effect of off-Pump coronary artery bypass Surgery on the risk of postoperative acute kidney injury and its association with mortality. Design: Observational cohort study. Setting: Tertiary care center. Patients: Some 10,061 patients underwent coronary artery bypass Surgery (1998-2002), of which 1,365 patients underwent off-Pump Surgery. Interventions: Acute kidney injury was defined as either requirement of dialysis or ≥50% decline in postoperative glomerular filtration rate but not requiring dialysis. We compared on- and off-Pump surgeries and used propensity score matching to examine the effect of off-Pump Surgery on acute kidney injury and mortality. Measurements and Main Results: We found that 2.6% on-Pump and 1.2% off-Pump patients developed acute kidney injury requiring dialysis among the 2,370 matched subjects (relative risk, 2.06; 95% confidence interval [Cl], 1.36-3.36); 5.0% of on-Pump patients suffered a ≥50% decline in glomerular filtration rate compared with 2.5% in off-Pump group (relative risk, 2.00; 95% Cl, 1.48-2.82). The mortality rate in the matched cohort was 2.3% for on-Pump group vs. 0.6% in off-Pump group (relative risk, 3.88; 95% Cl, 2.29-9.50). Among matched patients with acute kidney injury, the risk of mortality was 13.14 (95% Cl, 8.43-30.50) in patients requiring dialysis and 9.33 (95% Cl, 4.83-19.00) in those with ≥50% decline in glomerular filtration rate but not requiring dialysis. Conclusions: off-Pump Surgery is associated with a lower risk of developing acute kidney injury (regardless of its definition). The risk of mortality is incremental with worsening degrees of acute kidney injury. Lower risk of acute kidney injury may be one of the factors that offer a survival advantage after off-Pump Surgery.
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effect of off Pump coronary artery bypass graft Surgery on postoperative acute kidney injury and mortality
Critical Care Medicine, 2006Co-Authors: Charuhas V Thakar, Ethan Katz, Jean Pierre Yared, Joseph Sabik, Emil P PaganiniAbstract:OBJECTIVE: Risk of mortality after cardiac Surgery is associated with severity of acute kidney injury. The aim of this study is to examine the effect of off-Pump coronary artery bypass Surgery on the risk of postoperative acute kidney injury and its association with mortality. DESIGN: Observational cohort study. SETTING: Tertiary care center. PATIENTS: Some 10,061 patients underwent coronary artery bypass Surgery (1998-2002), of which 1,365 patients underwent off-Pump Surgery. INTERVENTIONS: Acute kidney injury was defined as either requirement of dialysis or >/=50% decline in postoperative glomerular filtration rate but not requiring dialysis. We compared on- and off-Pump surgeries and used propensity score matching to examine the effect of off-Pump Surgery on acute kidney injury and mortality. MEASUREMENTS AND MAIN RESULTS: We found that 2.6% on-Pump and 1.2% off-Pump patients developed acute kidney injury requiring dialysis among the 2,370 matched subjects (relative risk, 2.06; 95% confidence interval [CI], 1.36-3.36); 5.0% of on-Pump patients suffered a >/=50% decline in glomerular filtration rate compared with 2.5% in off-Pump group (relative risk, 2.00; 95% CI, 1.48-2.82). The mortality rate in the matched cohort was 2.3% for on-Pump group vs. 0.6% in off-Pump group (relative risk, 3.88; 95% CI, 2.29-9.50). Among matched patients with acute kidney injury, the risk of mortality was 13.14 (95% CI, 8.43-30.50) in patients requiring dialysis and 9.33 (95% CI, 4.83-19.00) in those with >/=50% decline in glomerular filtration rate but not requiring dialysis. CONCLUSIONS: off-Pump Surgery is associated with a lower risk of developing acute kidney injury (regardless of its definition). The risk of mortality is incremental with worsening degrees of acute kidney injury. Lower risk of acute kidney injury may be one of the factors that offer a survival advantage after off-Pump Surgery.
Charuhas V Thakar - One of the best experts on this subject based on the ideXlab platform.
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effect of off Pump coronary artery bypass graft Surgery on postoperative acute kidney injury and mortality
Critical Care Medicine, 2006Co-Authors: Charuhas V Thakar, Ethan Katz, Jean Pierre Yared, Joseph Sabik, Emil P PaganiniAbstract:Objective: Risk of mortality after cardiac Surgery is associated with severity of acute kidney injury. The aim of this study is to examine the effect of off-Pump coronary artery bypass Surgery on the risk of postoperative acute kidney injury and its association with mortality. Design: Observational cohort study. Setting: Tertiary care center. Patients: Some 10,061 patients underwent coronary artery bypass Surgery (1998-2002), of which 1,365 patients underwent off-Pump Surgery. Interventions: Acute kidney injury was defined as either requirement of dialysis or ≥50% decline in postoperative glomerular filtration rate but not requiring dialysis. We compared on- and off-Pump surgeries and used propensity score matching to examine the effect of off-Pump Surgery on acute kidney injury and mortality. Measurements and Main Results: We found that 2.6% on-Pump and 1.2% off-Pump patients developed acute kidney injury requiring dialysis among the 2,370 matched subjects (relative risk, 2.06; 95% confidence interval [Cl], 1.36-3.36); 5.0% of on-Pump patients suffered a ≥50% decline in glomerular filtration rate compared with 2.5% in off-Pump group (relative risk, 2.00; 95% Cl, 1.48-2.82). The mortality rate in the matched cohort was 2.3% for on-Pump group vs. 0.6% in off-Pump group (relative risk, 3.88; 95% Cl, 2.29-9.50). Among matched patients with acute kidney injury, the risk of mortality was 13.14 (95% Cl, 8.43-30.50) in patients requiring dialysis and 9.33 (95% Cl, 4.83-19.00) in those with ≥50% decline in glomerular filtration rate but not requiring dialysis. Conclusions: off-Pump Surgery is associated with a lower risk of developing acute kidney injury (regardless of its definition). The risk of mortality is incremental with worsening degrees of acute kidney injury. Lower risk of acute kidney injury may be one of the factors that offer a survival advantage after off-Pump Surgery.
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effect of off Pump coronary artery bypass graft Surgery on postoperative acute kidney injury and mortality
Critical Care Medicine, 2006Co-Authors: Charuhas V Thakar, Ethan Katz, Jean Pierre Yared, Joseph Sabik, Emil P PaganiniAbstract:OBJECTIVE: Risk of mortality after cardiac Surgery is associated with severity of acute kidney injury. The aim of this study is to examine the effect of off-Pump coronary artery bypass Surgery on the risk of postoperative acute kidney injury and its association with mortality. DESIGN: Observational cohort study. SETTING: Tertiary care center. PATIENTS: Some 10,061 patients underwent coronary artery bypass Surgery (1998-2002), of which 1,365 patients underwent off-Pump Surgery. INTERVENTIONS: Acute kidney injury was defined as either requirement of dialysis or >/=50% decline in postoperative glomerular filtration rate but not requiring dialysis. We compared on- and off-Pump surgeries and used propensity score matching to examine the effect of off-Pump Surgery on acute kidney injury and mortality. MEASUREMENTS AND MAIN RESULTS: We found that 2.6% on-Pump and 1.2% off-Pump patients developed acute kidney injury requiring dialysis among the 2,370 matched subjects (relative risk, 2.06; 95% confidence interval [CI], 1.36-3.36); 5.0% of on-Pump patients suffered a >/=50% decline in glomerular filtration rate compared with 2.5% in off-Pump group (relative risk, 2.00; 95% CI, 1.48-2.82). The mortality rate in the matched cohort was 2.3% for on-Pump group vs. 0.6% in off-Pump group (relative risk, 3.88; 95% CI, 2.29-9.50). Among matched patients with acute kidney injury, the risk of mortality was 13.14 (95% CI, 8.43-30.50) in patients requiring dialysis and 9.33 (95% CI, 4.83-19.00) in those with >/=50% decline in glomerular filtration rate but not requiring dialysis. CONCLUSIONS: off-Pump Surgery is associated with a lower risk of developing acute kidney injury (regardless of its definition). The risk of mortality is incremental with worsening degrees of acute kidney injury. Lower risk of acute kidney injury may be one of the factors that offer a survival advantage after off-Pump Surgery.
Gianni D Angelini - One of the best experts on this subject based on the ideXlab platform.
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Influence of Body Size on Clinical Outcome in Patients Undergoing Coronary Surgery with or Without Cardiopulmonary Bypass
Journal of Cardiac Surgery, 2020Co-Authors: R Ascoine, Karen Rees, Martin H. Chamberlain, Franco Ciulli, Alan J. Bryan, Gianni D AngeliniAbstract:Objective: Coronary artery bypass grafting (CABG) in overweight patients carries significant morbidity. We compare the effectiveness of off-Pump coronary artery bypass (OPCAB) Surgery versus conventional CABG using cardiopulmonary bypass and cardioplegic arrest, in a consecutive series of overweight patients. Methods: From April 1996 to April 2001, data from 4321 patients undergoing coronary revascularisation (mortality 1.4%) were prospectively entered into the Patients Analysis and Tracking System. Data were extracted for all patients with a body mass index (BMI) ≥ 25. In hospital mortality and early morbidity were compared between patients undergoing on- and off-Pump coronary Surgery. A risk-adjusted analysis was also carried out to assess the influence of Surgery on outcomes. Results: 2844 overweight patients with BMI ≥ 25 were identified, and of these 674 (23.7%) were operated on with off-Pump Surgery. On-Pump patients were less likely to have unstable angina, hypercholesterolaemia, to have coronary disease involving the left main stem, or to have a BMI ≥ 30. However, they had more extensive coronary disease, were more likely to have suffered previous myocardial infarction, and received more grafts than those undergoing off-Pump Surgery. Intra- and post-operative arrhythmias, inotropic use, and post-operative low cardiac output, use of IABP, blood loss, transfusion requirement, chest infections, neurological complications including permanent stroke, ICU and hospital stay all were significantly reduced in the off-Pump group (all p < 0.05). After adjustment for age, gender, ejection fraction, extent of coronary disease, and degree of urgency, odd ratios (ORs) for most of the adverse outcomes investigated, confirmed significant benefit of off-Pump Surgery (table). The point estimate of the adjusted effect size for in-hospital mortality also indicated benefit from off-Pump Surgery (table). Variable On-Pump (2169) off-Pump (674) OR/Mean Difference 95% CI p Death 20 (0.92%) 2 (0.29%) 0.37 0.08, 1.59 0.18 Postoperative MI 35 (1.6%) 14 (2.0%) 1.37 0.72, 2.62 0.337 New Inotropes 879 (40.5%) 219 (32.5%) 0.8 0.66, 0.97 0.02 New IABP 54 (2.5%) 5 (0.7%) 0.32 0.12, 0.8 0.015 Ward arrhythmia 320 (14.8%) 65 (9.6%) 0.63 0.47, 0.84 0.002 Chest Infection 106 (4.9%) 14 (2.1%) 0.43 0.24, 0.76 0.004 Neurolog. Complic. 59 (2.7%) 6 (0.9%) 0.36 0.15, 0.85 0.02 Blood Loss (ml) 939.9 (512.3) 856.2 (582.1) −60.8 −111.7, −9.87 0.019 Total RBCs (unit) 1.05 (1.51) 0.436 (1.52) −0.51 −0.65, −0.37 0.0001 Total Platelets (unit) 0.24 (0.81) 0.08 (0.455) −0.157 −0.23, −0.08 0.0001 Total FFP (unit) 0.49 (1.48) 0.126 (0.72) −0.38 −0.5, −0.25 0.0001 Sternal rewiring 17 (0.78%) 1 (0.14%) −0.22 0.03, 1.7 0.15 Renal complications 98 (4.5%) 24 (3.56%) −0.74 0.44, 1.25 0.265 Hospital stay (day) 7.76 (4.26) 6.64 (3.04) −0.94 −1.39, −0.49 0.0001 Conclusions: These results suggest that off-Pump Surgery is safe, effective and associated with reduced morbidity in overweight patients.
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off Pump versus on Pump bypass Surgery for left main coronary artery disease
Journal of the American College of Cardiology, 2019Co-Authors: Umberto Benedetto, John D Puskas, Arie Pieter Kappetein, Morris W Brown, Ferenc Horkay, Piet W Boonstra, Gabor Bogats, Nicolas Noiseux, Ovidiu Dressler, Gianni D AngeliniAbstract:Abstract Background Concerns remain for a greater risk of incomplete revascularization and reduced survival with off-Pump coronary artery bypass grafting (CABG) Surgery compared with on-Pump Surgery particularly in patients with left main disease and extensive underlying myocardial ischemia. Objectives This study sought to compare outcomes following off-Pump versus on-Pump Surgery for left main disease by performing a post hoc analysis from the multicenter, randomized EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial. Methods The EXCEL trial was designed to compare percutaneous coronary intervention with everolimus-eluting stents versus CABG in patients with left main disease. CABG was performed with or without cardiopulmonary bypass (on-Pump vs. off-Pump Surgery) according to the discretion of the operator. The 3-year outcomes in the off-Pump and on-Pump groups were compared using inverse probability of treatment weighting (IPTW) for treatment effect estimation. Results Among 923 CABG patients, 652 and 271 patients underwent on-Pump and off-Pump Surgery, respectively. Despite a similar extent of disease, off-Pump Surgery was associated with a lower rate of revascularization of the left circumflex coronary artery (84.1% vs. 90.0%; p = 0.01) and right coronary artery (31.1% vs. 40.6%; p = 0.007). After IPTW adjustment for baseline differences, off-Pump Surgery was associated with a significantly increased risk of 3-year all-cause death (8.8% vs. 4.5%; hazard ratio: 1.94; 95% confidence interval: 1.10 to 3.41; p = 0.02) and a nonsignificant difference in the risk for the composite endpoint of death, myocardial infarction, or stroke (11.8% vs. 9.2%; hazard ratio: 1.28; 95% confidence interval: 0.82 to 2.00; p = 0.28). Conclusions Among patients with left main disease treated with CABG in the EXCEL trial, off-Pump Surgery was associated with a lower rate of revascularization of the coronary arteries supplying the inferolateral wall and an increased risk of 3-year all-cause death compared with on-Pump Surgery.
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Acquiring Proficiency in off-Pump Surgery: Traversing the Learning Curve, Reproducibility, and Quality Control
The Annals of Thoracic Surgery, 2005Co-Authors: Gavin J. Murphy, Massimo Caputo, Chris A Rogers, Gianni D AngeliniAbstract:As the risk profile of patients considered for surgical revascularization worsens, the cumulative benefit of off-Pump coronary artery bypass (OPCAB) over conventional coronary artery bypass grafting, in terms of lower morbidity and reduced healthcare costs, may increase. There is still resistance to the introduction of OPCAB Surgery however, its practice is variable and surgical residents are rarely trained in these techniques. This article considers how the learning curve in OPCAB may be negotiated and prospectively monitored to ensure quality control. The evidence suggests that situations in which suitable senior expertise exists, OPCAB Surgery can be introduced into surgical practice and safely taught to trainees without detriment to patients. This is achieved by a progressive increase in the complexity of the case mix and careful early supervision. The introduction of OPCAB has coincided with the increasing use of control charts as quality control tools. Performance monitoring provides reassurance that patients are not being put at risk during the introduction of OPCAB; control chart methods can be used prospectively for real time performance monitoring by consultant surgeons and residents alike. These techniques may ultimately be used to determine proficiency and accreditation. Increasing use of parallel training techniques, the development of structured training programs that encompass OPCAB and other new technologies in cardiac Surgery, coupled with objective performance monitoring are warranted to meet the needs of a changing patient population.
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Coronary artery bypass grafting in patients over 70 years old: the influence of age and surgical technique on early and mid-term clinical outcomes.
European Journal of Cardio-Thoracic Surgery, 2002Co-Authors: Raimondo Ascione, Karen Rees, Martin H. Chamberlain, Kirkpatrick Santo, Giovanni Marchetto, F.c. Taylor, Gianni D AngeliniAbstract:Objective: To investigate the influence of age and modern techniques of coronary artery bypass grafting with or without cardiopulmonary bypass on early and mid-term mortality and morbidity in a consecutive series of elderly patients. Methods: From April 1996 to December 2000, data of 3842 patients undergoing coronary revascularisation were prospectively entered into a database. Data were extracted for 990 patients older than 70 years: (A) 70‐74 years, (n ¼ 659); (B) 75 or more years, (n ¼ 331). Results: A total of 990 elderly patients ($70 years) underwent coronary revascularisation, 219 (22.1%) with off-Pump Surgery. Elderly patients were more likely to have higher CCS, NYHA and EuroScores, history of previous MI, unstable angina, renal dysfunction, left main stem disease $50%, and to be urgent. However, they were less likely to be overweight. In-hospital mortality, occurrence of re-intubation, renal dysfunction, and hospital stay were significantly higher in this elderly group. Overall, the distribution of mortality was doubled in the female gender although this was not statistically significant. Patients undergoing on-Pump Surgery had lower EuroScore, were less likely to be .75 years of age, likely to have obesity or hypercholesterolaemia, or to have suffered a previous cerebro-vascular accident. However, they had more extensive coronary disease, were more likely to have unstable angina, and received more grafts than those undergoing off-Pump Surgery. After adjustment for prognostic variables, off-Pump Surgery was found to be associated with reduced inotropic use, intra-operative arrhythmias, blood loss and transfusion requirement when compared to on-Pump coronary Surgery (point estimates of odd ratios, 0.26‐0.87) (all P , 0:05). Mid-term mortality or cardiac-related events were similar in the two groups. Conclusions: Early but not mid-term mortality is higher in patients aged 75 or more years when compared with those aged 70‐74 years. off-Pump coronary artery bypass Surgery is safe and effective in the elderly population. q 2002 Elsevier Science B.V. All rights reserved.
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economic outcome of off Pump coronary artery bypass Surgery a prospective randomized study
The Annals of Thoracic Surgery, 1999Co-Authors: Raimondo Ascione, Clinton T Lloyd, Malcolm J Underwood, Attilio A Lotto, Antonis A Pitsis, Gianni D AngeliniAbstract:Abstract Background . Emphasis on cost containment in coronary artery bypass Surgery is becoming increasingly important in modern hospital management. The revival of interest in off-Pump (beating heart) coronary artery bypass Surgery may influence the economic outcome. This study examines these effects. Methods . Two hundred patients undergoing first-time coronary artery bypass Surgery were prospectively randomized to either conventional cardiopulmonary bypass and cardioplegic arrest or off-Pump Surgery. Variable and fixed direct costs were obtained for each group during operative and postoperative care. The data were analyzed using parametric methods. Results . There was no difference between the groups with respect to pre- and intraoperative patient variables. off-Pump Surgery was significantly less costly than conventional on-Pump Surgery with respect to operating materials, bed occupancy, and transfusion requirements (total mean cost per patient: on Pump, $3,731.6 ± 1,169.7 vs off-Pump, $2,615.13 ± 953.6; p Conclusions . off-Pump revascularization offers a safe, cost-effective alternative to conventional coronary revascularization with cardiopulmonary bypass and cardioplegic arrest.
Bhupender Singh Sengar - One of the best experts on this subject based on the ideXlab platform.
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Elective preoperative use of intra aortic balloon counterpulsation in high risk group of coronary artery disease patients to facilitate off Pump Surgery
Indian Journal of Thoracic and Cardiovascular Surgery, 2007Co-Authors: Harinder Singh Bedi, Charanbir Singh Sohal, Bhupender Singh SengarAbstract:Background To avoid the deleterious effects of cardio-pulmonary bypass, off Pump coronary artery bypass graft Surgery (OPCABG) is increasingly the procedure of choice in the majority of patients needing myocardial revascularization. However patients at high operative risk are sometimes not given the advantage of off Pump Surgery because of haemodynamic deterioration during displacement of the heart to access the target vessels, or deterioration per se due to the factor causing the high risk (eg unstable hemodynamics) leading to institution of cardio-pulmonary bypass (CPB). Preoperative intraaortic balloon counterpulsation (IABC) therapy improves cardiac performance and facilitates the access to the anastomotic site during off Pump coronary artery bypass grafting while maintaining haemodynamic stability.
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Elective preoperative use of intra aortic balloon counterpulsation in high risk group of coronary artery disease patients to facilitate off Pump Surgery
Indian Journal of Thoracic and Cardiovascular Surgery, 2007Co-Authors: Harinder Singh Bedi, Charanbir Singh Sohal, Bhupender Singh SengarAbstract:Background To avoid the deleterious effects of cardio-pulmonary bypass, off Pump coronary artery bypass graft Surgery (OPCABG) is increasingly the procedure of choice in the majority of patients needing myocardial revascularization. However patients at high operative risk are sometimes not given the advantage of off Pump Surgery because of haemodynamic deterioration during displacement of the heart to access the target vessels, or deterioration per se due to the factor causing the high risk (eg unstable hemodynamics) leading to institution of cardio-pulmonary bypass (CPB). Preoperative intraaortic balloon counterpulsation (IABC) therapy improves cardiac performance and facilitates the access to the anastomotic site during off Pump coronary artery bypass grafting while maintaining haemodynamic stability. Methods Two hundred and twelve patients for isolated coronary artery bypass grafting (CABG) between June 2000 and June 2006 were studied in whom preoperative IABC was instituted. Initially, the trial was started in two groups and patients were computer randomized to ‘IABC’ and ‘No IABC’ groups. The trial was abandoned after 15 cases in each group, because of the adverse outcomes in ‘No IABC’ group. Left main stenosis was present in 31.1%, triple vessel disease in 87.7%, recent myocardial infarction in 21.2%, 35.8% were hypertensive, and 32% were diabetic. Results Out of 212 cases in whom preoperative IABC was instituted OPCABG was possible in the majority (88.2%), while of 15 cases in ‘No IABP’ group all CABG were done on CPB. Mortality and average stay in ICU was markedly lower in patients where IABC was instituted preoperatively. Conclusions Elective preoperative IABC in patients with high-risk coronary artery disease permits OPCABG in the majority, reduces the ICU stay, leads to earlier weaning from intra aortic balloon Pump (IABP), reduces the morbidity and mortality, and is more economical.
Ethan Katz - One of the best experts on this subject based on the ideXlab platform.
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effect of off Pump coronary artery bypass graft Surgery on postoperative acute kidney injury and mortality
Critical Care Medicine, 2006Co-Authors: Charuhas V Thakar, Ethan Katz, Jean Pierre Yared, Joseph Sabik, Emil P PaganiniAbstract:Objective: Risk of mortality after cardiac Surgery is associated with severity of acute kidney injury. The aim of this study is to examine the effect of off-Pump coronary artery bypass Surgery on the risk of postoperative acute kidney injury and its association with mortality. Design: Observational cohort study. Setting: Tertiary care center. Patients: Some 10,061 patients underwent coronary artery bypass Surgery (1998-2002), of which 1,365 patients underwent off-Pump Surgery. Interventions: Acute kidney injury was defined as either requirement of dialysis or ≥50% decline in postoperative glomerular filtration rate but not requiring dialysis. We compared on- and off-Pump surgeries and used propensity score matching to examine the effect of off-Pump Surgery on acute kidney injury and mortality. Measurements and Main Results: We found that 2.6% on-Pump and 1.2% off-Pump patients developed acute kidney injury requiring dialysis among the 2,370 matched subjects (relative risk, 2.06; 95% confidence interval [Cl], 1.36-3.36); 5.0% of on-Pump patients suffered a ≥50% decline in glomerular filtration rate compared with 2.5% in off-Pump group (relative risk, 2.00; 95% Cl, 1.48-2.82). The mortality rate in the matched cohort was 2.3% for on-Pump group vs. 0.6% in off-Pump group (relative risk, 3.88; 95% Cl, 2.29-9.50). Among matched patients with acute kidney injury, the risk of mortality was 13.14 (95% Cl, 8.43-30.50) in patients requiring dialysis and 9.33 (95% Cl, 4.83-19.00) in those with ≥50% decline in glomerular filtration rate but not requiring dialysis. Conclusions: off-Pump Surgery is associated with a lower risk of developing acute kidney injury (regardless of its definition). The risk of mortality is incremental with worsening degrees of acute kidney injury. Lower risk of acute kidney injury may be one of the factors that offer a survival advantage after off-Pump Surgery.
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effect of off Pump coronary artery bypass graft Surgery on postoperative acute kidney injury and mortality
Critical Care Medicine, 2006Co-Authors: Charuhas V Thakar, Ethan Katz, Jean Pierre Yared, Joseph Sabik, Emil P PaganiniAbstract:OBJECTIVE: Risk of mortality after cardiac Surgery is associated with severity of acute kidney injury. The aim of this study is to examine the effect of off-Pump coronary artery bypass Surgery on the risk of postoperative acute kidney injury and its association with mortality. DESIGN: Observational cohort study. SETTING: Tertiary care center. PATIENTS: Some 10,061 patients underwent coronary artery bypass Surgery (1998-2002), of which 1,365 patients underwent off-Pump Surgery. INTERVENTIONS: Acute kidney injury was defined as either requirement of dialysis or >/=50% decline in postoperative glomerular filtration rate but not requiring dialysis. We compared on- and off-Pump surgeries and used propensity score matching to examine the effect of off-Pump Surgery on acute kidney injury and mortality. MEASUREMENTS AND MAIN RESULTS: We found that 2.6% on-Pump and 1.2% off-Pump patients developed acute kidney injury requiring dialysis among the 2,370 matched subjects (relative risk, 2.06; 95% confidence interval [CI], 1.36-3.36); 5.0% of on-Pump patients suffered a >/=50% decline in glomerular filtration rate compared with 2.5% in off-Pump group (relative risk, 2.00; 95% CI, 1.48-2.82). The mortality rate in the matched cohort was 2.3% for on-Pump group vs. 0.6% in off-Pump group (relative risk, 3.88; 95% CI, 2.29-9.50). Among matched patients with acute kidney injury, the risk of mortality was 13.14 (95% CI, 8.43-30.50) in patients requiring dialysis and 9.33 (95% CI, 4.83-19.00) in those with >/=50% decline in glomerular filtration rate but not requiring dialysis. CONCLUSIONS: off-Pump Surgery is associated with a lower risk of developing acute kidney injury (regardless of its definition). The risk of mortality is incremental with worsening degrees of acute kidney injury. Lower risk of acute kidney injury may be one of the factors that offer a survival advantage after off-Pump Surgery.
