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Off-pump versus on-pump coronary artery bypass grafting outcomes stratified by preoperative renal function.

Publication ,  Journal Article
Chawla, LS; Zhao, Y; Lough, FC; Schroeder, E; Seneff, MG; Brennan, JM
Published in: J Am Soc Nephrol
August 2012

Clinical trials of off-pump coronary artery bypass grafting (CABG) have largely excluded patients with CKD. Here, we sought to determine whether pump status affects outcomes in patients with CKD. Using a nonrandomized cohort of 742,909 non-emergent, isolated CABG cases, which included 158,561 off-pump cases, in the Society of Thoracic Surgery Database from 2004 through 2009, we evaluated the association between pump status (off-pump versus on-pump) and in-hospital death or incident renal replacement therapy (RRT) across strata of preoperative renal function. We used propensity methods to adjust patient- and center-level analyses for imbalances in baseline patient risk. Patients who received on-pump and off-pump CABG had similar mean age and distribution of preoperative estimated GFR (eGFR). In a propensity-weighted analysis, off-pump CABG was associated with a reduction in the composite in-hospital death or RRT, with patients having lower preoperative renal function exhibiting greater benefit, on average. The risk difference (on-pump minus off-pump) ranged from 0.05 (95% confidence interval, -0.06 to 0.16) per 100 patients for eGFR ≥ 90 ml/min per 1.73 m(2) to 3.66 (95% confidence interval, 2.14-5.18) per 100 patients for eGFR 15-29 ml/min per 1.73 m(2). Both component endpoints suggested the same trend. In summary, these data suggest that patients with CKD experience less death or incident RRT when treated with off-pump compared with on-pump CABG. The reduction in incident RRT, not death, drove this effect on the composite among patients with low eGFR. Prospective trials comparing these procedures in patients with impaired preoperative renal function are warranted.

Duke Scholars

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Published In

J Am Soc Nephrol

DOI

EISSN

1533-3450

Publication Date

August 2012

Volume

23

Issue

8

Start / End Page

1389 / 1397

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Renal Insufficiency
  • Renal Dialysis
  • Preoperative Period
  • Middle Aged
  • Male
  • Humans
  • Glomerular Filtration Rate
  • Female
 

Citation

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Chawla, L. S., Zhao, Y., Lough, F. C., Schroeder, E., Seneff, M. G., & Brennan, J. M. (2012). Off-pump versus on-pump coronary artery bypass grafting outcomes stratified by preoperative renal function. J Am Soc Nephrol, 23(8), 1389–1397. https://doi.org/10.1681/ASN.2012020122
Chawla, Lakhmir S., Yue Zhao, Fredrick C. Lough, Elizabeth Schroeder, Michael G. Seneff, and J Matthew Brennan. “Off-pump versus on-pump coronary artery bypass grafting outcomes stratified by preoperative renal function.J Am Soc Nephrol 23, no. 8 (August 2012): 1389–97. https://doi.org/10.1681/ASN.2012020122.
Chawla LS, Zhao Y, Lough FC, Schroeder E, Seneff MG, Brennan JM. Off-pump versus on-pump coronary artery bypass grafting outcomes stratified by preoperative renal function. J Am Soc Nephrol. 2012 Aug;23(8):1389–97.
Chawla, Lakhmir S., et al. “Off-pump versus on-pump coronary artery bypass grafting outcomes stratified by preoperative renal function.J Am Soc Nephrol, vol. 23, no. 8, Aug. 2012, pp. 1389–97. Pubmed, doi:10.1681/ASN.2012020122.
Chawla LS, Zhao Y, Lough FC, Schroeder E, Seneff MG, Brennan JM. Off-pump versus on-pump coronary artery bypass grafting outcomes stratified by preoperative renal function. J Am Soc Nephrol. 2012 Aug;23(8):1389–1397.

Published In

J Am Soc Nephrol

DOI

EISSN

1533-3450

Publication Date

August 2012

Volume

23

Issue

8

Start / End Page

1389 / 1397

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Renal Insufficiency
  • Renal Dialysis
  • Preoperative Period
  • Middle Aged
  • Male
  • Humans
  • Glomerular Filtration Rate
  • Female