Comparative study of Short term results between On-pump versus Off-pump CABG in Patients with Preoperative mild to moderate renal impairment
Authors: El safty Omar M.T , Kamal Manal M , Hussein Maha S , Mohammed Mohammed S.M 
Published: October 2021

Abstract

Background
Coronary artery diseases are one of the leading causes of death around the world. Great efforts to diagnose, evaluate, prevent and decreasing morbidity and mortality had been done. CABG is one of the most effective ways for treatment of CAD when compared to PCI or medical treatment. On pump CABG is the basic and gold standard technique for CABG surgery. Yet there are some burdensome complications from the use of CPB so surgeons developed off pump technique to decrease these complications.

Objective
In this study we compared the early results of isolated CABG, using onpump and off-pump, in patients with preoperative mild to moderate elevation of serum creatinine. We examined if off-pump coronary revascularization offers a superior renal protection and less in post-operative complications when compared with conventional coronary revascularization with cardiopulmonary bypass.

Methods
This study was prospective cohort, observational study, conducted in post open heart ICU at Ain Shams university hospitals, 6th October insurance hospital and National Heart Institute during the period between October 2018 and April 2019. We enrolled 1st 100 consecutive adult patients scheduled for isolated CABG surgery (with a median sternotomy) with or without cardiopulmonary bypass pump. The patients are allocated in 2 groups where 50 patients in each group (group A – On pump – ONCAB- conventional surgery) and (group B – Off pump –OPCAB – beating heart) after obtaining their written informed consent without cross over between both groups.

Results
In this study, we found that postoperative AKI among both study group was relatively common defined by AKIN criteria and there was significant difference between the incidences of postoperative AKI among both study groups. It was higher in ONCAB group than OPCAB group (52%, 30% respectively) with (p-value = 0.025). According to AKIN classification for complicated cases with postoperative renal impairment; there were 32% among ONCAB group had AKIN stage 1 renal impairment versus 22% among OPCAB group had the same stage. While, there were 6% versus 2% had AKIN stage 2 renal impairment among ONCAB group versus OPCAB group respectively. Also there were 14% versus 6% had AKIN stage 3 renal impairment among ONCAB group versus OPCAB group respectively. The need for dialysis was much greater in the ONCAB group 20% versus 8% in the OPCAB group with significant p-value (0.029). Early mortality was significantly higher in ONCAB group about 11 cases (22%) VS 4 cases (8%) in OPCAB group with p-value 0.033. Also there was statistically significant difference between ONCAB group and OPCAB group according to drainage amount (p-value 0.028), re-exploration for bleeding (p-value 0.018), mean ICU stay (p-value 0.027) and mean hospital stay (p-value 0.009).

Conclusion
The off pump CABG is superior and gives more renal protection in patients with preoperative mild to moderate renal impairment. It is also reducing the early mortality and morbidity in these patients.