Off-Pump Versus On-Pump Coronary Artery Bypass Surgery in Ischemic Heart Disease Patients with Impaired Contractility and Renal Dysfunction: A Comparative Study | ||||
| International Journal of Medical Arts | ||||
| Article 11, Volume 3, Issue 1, January 2021, Page 976-983 PDF (1.07 MB) | ||||
| Document Type: Review Article | ||||
| DOI: 10.21608/ijma.2020.43214.1173 | ||||
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| Authors | ||||
Khalid Abdelsamad  1; Mohamed Shaffik Hassan2; Mohamed Eldesouky Sharaa2; Ismail Nasr Elsokkary2
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| 1Department of Cardiothoracic Surgery, Faculty of Medicine, Banysuef University, Banysuef, Egypt | ||||
| 2Department of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar University, Egypt | ||||
| Abstract | ||||
| Background: Coronary artery bypass surgery using cardiopulmonary bypass [CPB] carries the risk of renal impairment, which cannot be attributed to a single factor. This study compared the off-pump technique with the on-pump technique on kidney function in ischemic heart disease patients. Aim of the work: The study aimed to compare off-pump with on-pump technique on kidney and heart functions in patients with renal impairment with no need for dialysis but with impaired Ejection fraction [EF]. Patients and methods: This prospective non-randomized study included 60 patients who presented with symptoms of ischemic heart disease and subsequently underwent myocardial revascularization with preoperative serum creatinine levels between 1.6 to 2.5 mg/dl and EF below 45%. Patients were as following: Group A patients [on-pump]: included those who underwent surgery on cardiopulmonary bypass. Group B patients [off-pump]: included those who underwent off-pump surgery. Both groups were compared in terms of renal impairment markers and needed for dialysis and early postoperative outcome. Results: Renal impairment needs management by dialysis was developed in nine patients [30%] in the pump group [group I] and two patients [7.67%] in the off-pump group, with a significant difference. Group [I] showed a significant increase of transfused blood, blood urea nitrogen, serum creatinine, acute kidney injury [13 patients], reopening for bleeding, postoperative renal impairment, need for renal dialysis, total intensive care unit stay, and the total duration of hospital admission. However, it had a significant reduction in hemoglobin and creatinine clearance. Conclusion: Off-pump coronary revascularization offers a better kidney function preservation and has a decreased risk for kidney dysfunction in patients with renal impairment without dialysis compared with coronary revascularization with cardiopulmonary bypass. | ||||
| Keywords | ||||
| Coronary artery; On Pump; Coronary revascularization; Renal insufficiency; Dialysis | ||||
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