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. 2024 Feb 13:11:1341123.
doi: 10.3389/fcvm.2024.1341123. eCollection 2024.

Effect of on-pump vs. off-pump coronary artery bypass grafting in patients with non-dialysis-dependent severe renal impairment: propensity-matched analysis from the UK registry dataset

Daniel P Fudulu  1 , Amerikos Argyriou  1 , Rahul Kota  2 , Jeremy Chan  1 , Hunaid Vohra  1 , Massimo Caputo  1 , Mustafa Zakkar  1 , Gianni D Angelini  1
Affiliations

Effect of on-pump vs. off-pump coronary artery bypass grafting in patients with non-dialysis-dependent severe renal impairment: propensity-matched analysis from the UK registry dataset

Daniel P Fudulu et al. Front Cardiovasc Med. .

Abstract

Introduction: On-pump coronary artery bypass (ONCABG) grafting in patients with a pre-existing poor renal reserve is known to carry significant morbidity and mortality. There is limited controversial evidence on the benefit of off-pump coronary artery bypass (OPCABG) grafting in these high-risk groups of patients. We compared early clinical outcomes in propensity-matched cohorts of patients with non-dialysis-dependent pre-operative severe renal impairment undergoing OPCABG vs. ONCABG, captured in a large national registry dataset.

Methods: All data for patients with a pre-operative creatinine clearance of less than 50 mL/min who underwent elective or urgent isolated OPCABG or ONCABG from 1996 to 2019 were extracted from the UK National Adult Cardiac Surgery Audit (NACSA) database. Propensity score matching was performed using 1:1 nearest neighbor matching without replacement using several baseline characteristics. We investigated the effect of ONCABG vs. OPCABG in the matched cohort using cluster-robust standard error regression.

Results: We identified 8,628 patients with severe renal impairment undergoing isolated CABG, of whom 1,142 (13.23%) underwent OPCABG during the study period. We compared 1,141 propensity-matched pairs of patients undergoing OPCABG vs. ONCABG. The median age of the matched population was 78 years in both groups, with no significant imbalance post-matching in the rest of the variables. There was no difference between OPCABG and ONCABG in in-hospital mortality rates, post-operative dialysis, and stroke rates. However, the return to theatre for bleeding or tamponade was higher in ONCABG vs. OPCABG (P > 0.02); however, OPCABG reduced the total length of stay in the hospital by 1 day (P = 0.008). After double adjustment in the matched population using cluster-robust standard regression, ONCABG did not increase mortality compared to OPCABG (OR, 1.05, P = 0.78), postoperative stroke (OR, 1.7, P = 0.12), and dialysis (OR, 0.7, P = 0.09); however, ONCABG was associated with an increased risk of bleeding (OR, 1.53, P = 0.03).

Discussion: In this propensity analysis of a large national registry dataset, we found no difference in early mortality and stroke in patients with pre-operative severe renal impairment undergoing OPCABG or ONCABG surgery; however, ONCABG was associated with an increased risk of return to theatre for bleeding and an increased length of hospital stay.

Keywords: coronary artery bypass grafting; coronary disease; off-pump coronary artery bypass grafting; outcomes; renal dysfunction.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers at the time of submission. This had no impact on the peer review process or the final decision.

Figures

Figure 1
Figure 1
Study scheme.
Figure 2
Figure 2
Covariate balance between unmatched and matched OPCABG and ONCABG cohorts.
See this image and copyright information in PMC

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References

    1. Abu-Omar Y, Ratnatunga C. Cardiopulmonary bypass and renal injury. Perfusion. (2006) 21(4):209–13. 10.1191/0267659106pf870oa - DOI - PubMed
    1. Garg AX, Devereaux PJ, Yusuf S, Cuerden MS, Parikh CR, Coca SG, et al. Kidney function after off-pump or on-pump coronary artery bypass graft surgery: a randomized clinical trial. JAMA. (2014) 311(21):2191–8. 10.1001/jama.2014.4952 - DOI - PubMed
    1. Merkle J, Sunny J, Ehlscheid L, Sabashnikov A, Weber C, Eghbalzadeh K, et al. Early and long-term outcomes of coronary artery bypass surgery with and without use of heart-lung machine and with special respect to renal function—a retrospective study. PLoS One. (2019) 14(10):e0223806. 10.1371/journal.pone.0223806 - DOI - PMC - PubMed
    1. Wang Y, Zhu S, Gao P, Zhou J, Zhang Q. Off-pump versus on-pump coronary surgery in patients with chronic kidney disease: a meta-analysis. Clin Exp Nephrol. (2018) 22(1):99–109. 10.1007/s10157-017-1432-7 - DOI - PubMed
    1. Sajja LR, Mannam G, Chakravarthi RM, Sompalli S, Naidu SK, Somaraju B, et al. Coronary artery bypass grafting with or without cardiopulmonary bypass in patients with preoperative non-dialysis dependent renal insufficiency: a randomized study. J Thorac Cardiovasc Surg. (2007) 133(2):378–88. 10.1016/j.jtcvs.2006.09.028 - DOI - PubMed

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