Off-pump versus on-pump coronary artery bypass surgery and postoperative renal dysfunction

Renal dysfunction is a serious complication after coronary bypass surgery with cardiopulmonary bypass (CABG). Because duration of cardiopulmonary bypass (CPB) is associated with renal outcome, it has been proposed that avoidance of CPB with off-pump coronary bypass (OPCAB) may reduce perioperative renal insult. We therefore tested the hypothesis that OPCAB is associated with less postoperative renal dysfunction compared with CABG surgery. With IRB approval, we gathered data for 690 primary elective coronary bypass patients (OPCAB, 55; CABG, 635). Perioperative change in creatinine clearance (DCrCl) was calculated by using preoperative (CrPre) and peak postoperative (CrPost) serum creatinine values, and the Cockroft-Gault equation (DCrCl = CrPreCl - CrPostCl). Univariate and linear multivariate tests were used in this retrospective analysis; P: < 0.05 was considered significant. Multivariate analysis did not identify OPCAB surgery as an independent predictor of DCrCl. However, previously reported associations of PreCrCl, age, and diabetes with DCrCl were confirmed. Power analysis demonstrated an 80% power to detect a 7.0 mL/min DCrCl difference between study groups. In this retrospective study, we could not confirm that OPCAB significantly reduces perioperative renal dysfunction compared with CABG surgery. Our findings suggest that reduction of renal risk alone should not be an indication for OPCAB over CABG surgery. Implications: Retrospective analysis did not identify any significant difference in perioperative change in creatinine clearance after coronary revascularization with cardiopulmonary bypass compared with off-pump coronary surgery.