Renal dysfunction in high-risk patients after on-pump and off-pump coronary artery bypass surgery: a propensity score analysis.

BACKGROUND: Cardiopulmonary bypass may be a causal factor in the development of renal impairment after cardiac surgery. When acute renal failure requiring dialysis occurs after cardiac surgery, it is associated with high mortality. We attempted to determine whether off-pump coronary artery bypass grafting surgery prevents postoperative renal dysfunction in patients at high risk for renal failure.

METHODS: Retrospective analysis identified 2,869 patients who had preexisting renal dysfunction (preoperative creatinine clearance less than 60 mL/min) and who underwent isolated coronary artery bypass grafting between 1995 and 2003. Patients who required preoperative dialysis were excluded. Propensity scores were computed to match off-pump coronary artery bypass surgery patients 3:1 with those who underwent conventional coronary artery bypass grafting surgery, and the independent predictors of postoperative renal dysfunction were determined.

RESULTS: Two thousand seven hundred eleven patients with preexisting renal dysfunction underwent conventional coronary artery bypass grafting surgery, and 158 patients underwent coronary artery bypass grafting surgery without cardiopulmonary bypass (off-pump coronary artery bypass grafting surgery group). The matched groups showed no differences in any of the preoperative or postoperative variables examined. Diabetes (odds ratio, 1.96; p = 0.01), peripheral vascular disease (odds ratio, 2.50; p < 0.001), and reduced preoperative creatinine clearance (odds ratio, 1.02; p = 0.02) were independent risk factors for the development of postoperative renal dysfunction. Off-pump coronary artery bypass grafting surgery was not associated with a decreased risk of renal dysfunction by univariate or multivariable analysis.

CONCLUSIONS: Off-pump coronary artery bypass grafting surgery did not reduce the risk of postoperative renal dysfunction in this large, unselected, sequential series of patients at high risk for renal failure after coronary artery bypass grafting surgery. Our results suggest that renal function should not be a deciding factor when determining whether or not a patient undergoes off-pump coronary artery bypass grafting surgery.