Is Off-Pump Revascularization Better for Patients with Non-Dialysis-Dependent Renal Insufficiency?

  • Robert B. Beauford
  • Craig R. Saunders
  • Leo A. Niemeier
  • Troy Adam Lunceford
  • Ravindra Karanam
  • Thomas Prendergast
  • Shamji Shah
  • Paul Burns
  • Frederick Sardari
  • Daniel J. Goldstein


Background: Renal dysfunction is a well-recognized complication following coronary artery bypass grafting (CABG). Coronary revascularization without cardiopulmonary bypass (CPB) has been shown to minimize renal injury in patients with normal preoperative renal function who undergo elective procedures. The purpose of this study was to define the effect of an off-pump revascularization strategy on the incidence of postoperative renal failure and survival of patients with preexisting renal dysfunction.

Methods: From January 1, 1999, to December 1, 2002, a total of 371 patients were identified as having a preoperative creatinine concentration greater than or equal to 1.5 mg/dL. This number included 291 patients who did not need hemodialysis or peritoneal dialysis to support renal function. These patients were subdivided into those undergoing traditional CABG with CPB (103 patients) and those undergoing off-pump revascularization (188 patients) whose demographic, operative, and outcome information was retrospectively reviewed and compared.

Results: The off-pump cohort was older than the on-pump cohort (70 ± 9.6 versus 66 ± 10.9 years; P = .002), had a lower prevalence of previous myocardial infarction (35% versus 50%; P = .008), and had a modestly higher mean left ventricular ejection fraction (0.47 ± 0.01 versus 0.43 ± 0.01; P = .017). Otherwise the groups were well matched. The mean preoperative serum creatinine and creatinine clearance values were not significantly different (1.8 ± 0.5 versus 1.9 ± 0.6 mg/dL [P = .372] and 45.1 ± 15.5 versus 46.8 ± 17.2 mL/min [P = .376] for the off-pump and on-pump cohorts, respectively). There was a significant reduction in postoperative renal failure (17% versus 9% of patients; P = .020) and need for new dialysis (10% versus 3% of patients; P = .022) when CPB was eliminated. Intermediate-term survival analysis revealed a survival benefit for the off-pump group (70% versus 57%) at 42 months, although this value did not reach statistical significance (P = .143). Conclusion: The results of this study suggested that patients with preoperative non-dialysis-dependent renal insufficiency have more favorable outcome when revascularization is done off pump. Avoidance of CPB results in (1) a reduction in the incidence of postoperative renal failure; (2) a reduction in the need for new dialysis; and (3) improved in-hospital and midterm survival.


Dacey LJ, Liu JY, Braxton JH, et al. 2002. Long-term survival of dialysis patients after coronary bypass grafting. Ann Thorac Surg 74:458-62.\nDurmaz I, Buket S, Atay Y, et al. 1999. Cardiac surgery with cardiopulmonary bypass in patients with chronic renal failure. J Thorac Cardiovasc Surg 118:306-15.\nGamoso MG, Phillips-Bute B, Landolfo KP, et al. 2000. Off-pump versus on-pump coronary artery bypass surgery and postoperative renal dysfunction. Anesth Analg 91:1080-4.\nGerritsen WB, van Boven WJ, Driessen AH, et al. 2001. Off-pump versus on-pump coronary artery bypass grafting: oxidative stress and renal function. Eur J Cardiothorac Surg 20:923-9.\nHerzog CA, Ma JZ, Collins AJ. 1999. Long-term outcome of dialysis patients in the United States with coronary revascularization procedures. Kidney Int 56:324-32.\nLiu JY, Birkmeyer NJ, Sanders JH, et al. 2000. Risks of morbidity and mortality in dialysis patients undergoing coronary artery bypass surgery. Northern New England Cardiovascular Disease Study Group. Circulation 102:2973-7.\nTang AT, Knott J, Nanson J, et al. 2002. A prospective randomized study to evaluate the renoprotective action of beating heart coronary surgery in low risk patients. Eur J Cardiothorac Surg 22:118-23.\nWilliams BC, Demitrack LB, Fries BE. 1992. The accuracy of the National Death Index when personal identifiers other than Social Security number are used. Am J Public Health 82:1145-7.\nAbel RM, Buckley MJ, Austen WG, et al. 1976. Etiology, incidence, and prognosis of renal failure following cardiac operations: results of a prospective analysis of 500 consecutive patients. J Thorac Cardiovasc Surg 71:323-33.\nAscione R, Lloyd CT, Underwood MJ, et al. 1999. On-pump versus off-pump coronary revascularization: evaluation of renal function. Ann Thorac Surg 68:493-8.\nAscione R, Nason G, Al-Ruzzeh S, et al. 2001. Coronary revascularization with or without cardiopulmonary bypass in patients with preoperative nondialysis-dependent renal insufficiency. Ann Thorac Surg 72:2020-5.\nChertow GM, Lazarus JM, Christiansen CL, et al. 1997. Preoperative renal risk stratification. Circulation 95:878-84.\nChertow GM, Levy EM, Hammermeister KE, et al. 1998. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med 104:343-8.\nCockcroft DW, Gault MH. 1976. Prediction of creatinine clearance from serum creatinine. Nephron 16:31-41.\nLoef BG, Epema AH, Navis G, et al. 2002. Off-pump coronary revascularization attenuates transient renal damage compared with on-pump coronary revascularization. Chest 121:1190-4.\nMangano CM, Diamondstone LS, Ramsay JG, et al. 1998. Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. The Multicenter Study of Perioperative Ischemia Research Group. Ann Intern Med 128:194-203.\nNakayama Y, Sakata R, Ura M, et al. 2003. Long-term results of coronary artery bypass grafting in patients with renal insufficiency. Ann Thorac Surg 75:496-500.\nPenta de Peppo A, Nardi P, De Paulis R, et al. 2002. Cardiac surgery in moderate to end-stage renal failure: analysis of risk factors. Ann Thorac Surg 74:378-83.\nRao V, Weisel RD, Buth KJ, et al. 1997. Coronary artery bypass grafting in patients with non-dialysis-dependent renal insufficiency. Circulation 96(9 suppl):II-38-43.\nSTS National Database Adult Cardiac Surgery Section-version 2.41. Core elements: summary. Available at: 241Book.pdf. Accessed: January 31, 2003.\nSzczech LA, Best PJ, Crowley E, et al. 2002. Outcomes of patients with chronic renal insufficiency in the bypass angioplasty revascularization investigation. Circulation 105:2253-8.\n
How to Cite
Beauford, R. B., Saunders, C. R., Niemeier, L. A., Lunceford, T. A., Karanam, R., Prendergast, T., Shah, S., Burns, P., Sardari, F., & Goldstein, D. J. (2005). Is Off-Pump Revascularization Better for Patients with Non-Dialysis-Dependent Renal Insufficiency?. The Heart Surgery Forum, 7(2), 84-89.

Most read articles by the same author(s)