Kidney function after off-pump or on-pump coronary artery bypass grafting in the high-risk surgical patients

Aim: Theoretically, off-pump coronary artery bypass appears to have less impact on kidney function. We estimated the primary marker of renal dysfunction in patients with high surgical risk who underwent off-pump and on-pump coronary artery bypass.

Material and Methods: We retrospectively analysed 1339 patients with high surgical risk who underwent isolated coronary artery bypass grafting. Patients were divided into two groups: Off-pump (n=672) and On-pump (n=667) coronary artery bypass. We measured kidney function tests for five days after surgery and before discharge and then compared the results with preoperative levels.

Results: In the On-pump group, a statistically significant increase in creatinine concentration was observed on the fifth day after surgery (p=0.0001) and it persisted until the patient’s discharge (p = 0.043). In the Off-pump group, a statistically significant difference was noted on the fifth day (p = 0.054); however, before discharge from hospital, the statistical significance was not revealed (p=0.735). The patients with chronic kidney disease after on-pump CABG had a statistically significant increase in urea level (p=0.0021) postoperatively, and more frequent need for hemodialysis Off-pump 2% (n=3), On-pump 7.3% (n=12), p=0.28.

Conclusion: Off-pump coronary artery bypass showed a less negative impact on kidney function than surgery with extracorporeal circulation and can be recommended for high-risk surgical patients.