Early and long-term outcomes of coronary artery bypass surgery with and without use of heart-lung machine and with special respect to renal function - A retrospective study

Autoři: Julia Merkle aff001;  Jaison Sunny aff001;  Laura Ehlscheid aff001;  Anton Sabashnikov aff001;  Carolyn Weber aff001;  Kaveh Eghbalzadeh aff001;  Ilija Djordjevic aff001;  Oliver Liakopoulos aff001;  Yeong-Hoon Choi aff001;  Thorsten Wahlers aff001;  Mohamed Zeriouh aff001
Působiště autorů: Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany aff001
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223806


The aim of our study was to compare early and long-term outcome of patients undergoing either on-pump or off-pump coronary artery bypass grafting with special focus on impairment of renal function. Five hundred ninety-three consecutive patients undergoing coronary artery bypass grafting were retrospectively analyzed. They were assigned either to on-pump (n = 281) or to off-pump (n = 312) group. Early and long-term outcomes were analyzed with special focus on renal function. Basic demographics and preoperative characteristics did not differ between groups (p>0.05) as well as postoperative renal parameters (p>0.05). Postoperative odds ratios (OR) of off-pump group in comparison to on-pump group were higher without reaching significance in terms of incidence of gastrointestinal complications and pneumonia (OR = 2.23 and 1.61, respectively) as well as hazard ratios (HR) on long-term follow-up for mortality and incidence of myocardial infarction (HR = 1.50 and 2.29, respectively). Kaplan-Meier estimation analysis also revealed similar results for both groups in terms of mid- and long-term survival (Breslow p = 0.062 and Log-Rank p = 0.064, respectively) and for incidence of myocardial infarction (Breslow p = 0.102 and Log-Rank p = 0.103, respectively). Our study suggests that use or not use of coronary artery bypass did not influence postoperative renal function. Odds of early outcomes were similar in both groups as well as incidence of myocardial infarction and mortality in long-term follow-up.

Klíčová slova:

Coronary artery bypass grafting – Creatinine – Myocardial infarction – Pneumonia – Renal system – Surgical and invasive medical procedures – Vascular surgery – Cardiopulmonary bypass


1. Puskas JD, Williams WH, Duke PG, Staples JR, Glas KE, Marshall JJ, et al. Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003;125(4):797–808. doi: 10.1067/mtc.2003.324 12698142

2. Sedrakyan A, Wu AW, Parashar A, Bass EB, Treasure T. Off-pump surgery is associated with reduced occurrence of stroke and other morbidity as compared with traditional coronary artery bypass grafting: a meta-analysis of systematically reviewed trials. Stroke. 2006;37(11):2759–69. doi: 10.1161/01.STR.0000245081.52877.f2 17008617

3. Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Straka Z, et al. Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting. N Engl J Med. 2016;375(24):2359–68. doi: 10.1056/NEJMoa1601564 27771985

4. Nicolini F, Fortuna D, Contini GA, Pacini D, Gabbieri D, Zussa C, et al. Comparison between off- and on-pump coronary artery bypass grafting: long-term results of a real-world registry. Eur J Cardiothorac Surg. 2016;50(3):528–35. doi: 10.1093/ejcts/ezw128 27118313

5. Staton GW, Williams WH, Mahoney EM, Hu J, Chu H, Duke PG, et al. Pulmonary outcomes of off-pump vs on-pump coronary artery bypass surgery in a randomized trial. Chest. 2005;127(3):892–901. doi: 10.1378/chest.127.3.892 15764773

6. Puskas JD, Williams WH, Mahoney EM, Huber PR, Block PC, Duke PG, et al. Off-pump vs conventional coronary artery bypass grafting: early and 1-year graft patency, cost, and quality-of-life outcomes: a randomized trial. JAMA. 2004;291(15):1841–9. doi: 10.1001/jama.291.15.1841 15100202

7. Takagi H, Tanabashi T, Kawai N, Umemoto T. Off-pump surgery does not reduce stroke, compared with results of on-pump coronary artery bypass grafting: a meta-analysis of randomized clinical trials. J Thorac Cardiovasc Surg. 2007;134(4):1059–60. doi: 10.1016/j.jtcvs.2007.07.006 17903537

8. Bakaeen FG, Chu D, Kelly RF, Ward HB, Jessen ME, Chen GJ, et al. Performing coronary artery bypass grafting off-pump may compromise long-term survival in a veteran population. Ann Thorac Surg. 2013;95(6):1952–8; discussion 9–60. doi: 10.1016/j.athoracsur.2013.02.064 23647861

9. Wang Y, Zhu S, Gao P, Zhou J, Zhang Q. Off-pump versus on-pump coronary surgery in patients with chronic kidney disease: a meta-analysis. Clin Exp Nephrol. 2018;22(1):99–109. doi: 10.1007/s10157-017-1432-7 28634771

10. Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E, et al. Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. N Engl J Med. 2013;368(13):1179–88. doi: 10.1056/NEJMoa1301228 23477676

11. Diegeler A, Reents W, Zacher M. Off-pump or on-pump coronary-artery bypass grafting. N Engl J Med. 2013;369(2):196–7.

12. Houlind K, Fenger-Gron M, Holme SJ, Kjeldsen BJ, Madsen SN, Rasmussen BS, et al. Graft patency after off-pump coronary artery bypass surgery is inferior even with identical heparinization protocols: results from the Danish On-pump Versus Off-pump Randomization Study (DOORS). J Thorac Cardiovasc Surg. 2014;148(5):1812–9 e2. doi: 10.1016/j.jtcvs.2014.02.024 24613160

13. Magee MJ, Coombs LP, Peterson ED, Mack MJ. Patient selection and current practice strategy for off-pump coronary artery bypass surgery. Circulation. 2003;108 Suppl 1:II9–14.

14. Spina S, Lei C, Pinciroli R, Berra L. Hemolysis and Kidney Injury in Cardiac Surgery: The Protective Role of Nitric Oxide Therapy. Semin Nephrol. 2019;39(5):484–95. doi: 10.1016/j.semnephrol.2019.06.008 31514912

15. Zaouter C, Potvin J, Bats ML, Beauvieux MC, Remy A, Ouattara A. A combined approach for the early recognition of acute kidney injury after adult cardiac surgery. Anaesth Crit Care Pain Med. 2018;37(4):335–41. doi: 10.1016/j.accpm.2018.05.001 29777769

16. Boyd WD, Desai ND, Del Rizzo DF, Novick RJ, McKenzie FN, Menkis AH. Off-pump surgery decreases postoperative complications and resource utilization in the elderly. Ann Thorac Surg. 1999;68(4):1490–3. doi: 10.1016/s0003-4975(99)00951-0 10543551

17. Kim HJ, Chung JE, Jung JS, Kim IS, Son HS. Current Status of Off-pump Coronary Artery Bypass Grafting in Patients with Multiple Coronary Artery Disease Compared with On-pump Coronary Artery Bypass Grafting: The Korean National Cohort Study. Thorac Cardiovasc Surg. 2018;66(6):470–6. doi: 10.1055/s-0038-1651516 29852507

18. Dai Z, Chu H, Wang S, Liang Y. The effect of tranexamic acid to reduce blood loss and transfusion on off-pump coronary artery bypass surgery: A systematic review and cumulative meta-analysis. J Clin Anesth. 2018;44:23–31. doi: 10.1016/j.jclinane.2017.10.004 29107853

19. Lycops A, Wever C, Vandekerkhof J, Mees U, Hendrikx M. Midterm follow-up after off-pump versus on-pump coronary artery bypass grafting. Results from a case-matched study. Acta Cardiol. 2005;60(3):311–7. doi: 10.2143/AC.60.3.2005010 15999472

20. Medved I, Anic D, Zrnic B, Ostric M, Saftic I. Off-pump versus on-pump—intermittent aortic cross clamping—myocardial revascularisation: single center expirience. Coll Antropol. 2008;32(2):381–4. 18756885

21. Fortuna D, Nicolini F, Guastaroba P, De Palma R, Di Bartolomeo S, Saia F, et al. Coronary artery bypass grafting vs percutaneous coronary intervention in a 'real-world' setting: a comparative effectiveness study based on propensity score-matched cohorts. Eur J Cardiothorac Surg. 2013;44(1):e16–24. doi: 10.1093/ejcts/ezt197 23628951

22. Paunel-Gorgulu A, Wacker M, El Aita M, Hassan S, Schlachtenberger G, Deppe A, et al. cfDNA correlates with endothelial damage after cardiac surgery with prolonged cardiopulmonary bypass and amplifies NETosis in an intracellular TLR9-independent manner. Sci Rep. 2017;7(1):17421. doi: 10.1038/s41598-017-17561-1 29234042

23. Merkle J, Daka A, Deppe AC, Wahlers T, Paunel-Gorgulu A. High levels of cell-free DNA accurately predict late acute kidney injury in patients after cardiac surgery. PLoS One. 2019;14(6):e0218548. doi: 10.1371/journal.pone.0218548 31211810

24. Caputo M, Mokhtari A, Miceli A, Ghorbel MT, Angelini GD, Parry AJ, et al. Controlled reoxygenation during cardiopulmonary bypass decreases markers of organ damage, inflammation, and oxidative stress in single-ventricle patients undergoing pediatric heart surgery. J Thorac Cardiovasc Surg. 2014;148(3):792–801 e8; discussion 0–1. doi: 10.1016/j.jtcvs.2014.06.001 25052821

25. Li Z, Fan G, Zheng X, Gong X, Chen T, Liu X, et al. Risk factors and clinical significance of acute kidney injury after on-pump or off-pump coronary artery bypass grafting: a propensity score-matched study. Interact Cardiovasc Thorac Surg. 2019;28(6):893–9. doi: 10.1093/icvts/ivy353 30649484

26. Sander M, von Heymann C, von Dossow V, Spaethe C, Konertz WF, Jain U, et al. Increased interleukin-6 after cardiac surgery predicts infection. Anesth Analg. 2006;102(6):1623–9. doi: 10.1213/01.ane.0000215998.21739.48 16717298

27. Amini S, Najafi MN, Karrari SP, Mashhadi ME, Mirzaei S, Tashnizi MA, et al. Risk Factors and Outcome of Acute Kidney Injury after Isolated CABG Surgery: a Prospective Cohort Study. Braz J Cardiovasc Surg. 2019;34(1):70–5. doi: 10.21470/1678-9741-2017-0209 30810677

28. Puskas JD, Kilgo PD, Lattouf OM, Thourani VH, Cooper WA, Vassiliades TA, et al. Off-pump coronary bypass provides reduced mortality and morbidity and equivalent 10-year survival. Ann Thorac Surg. 2008;86(4):1139–46; discussion 46. doi: 10.1016/j.athoracsur.2008.05.073 18805149

29. Chu D, Bakaeen FG, Dao TK, LeMaire SA, Coselli JS, Huh J. On-pump versus off-pump coronary artery bypass grafting in a cohort of 63,000 patients. Ann Thorac Surg. 2009;87(6):1820–6; discussion 6–7. doi: 10.1016/j.athoracsur.2009.03.052 19463602

30. Bucerius J, Gummert JF, Walther T, Borger MA, Doll N, Falk V, et al. Impact of off-pump coronary bypass grafting on the prevalence of adverse perioperative outcome in women undergoing coronary artery bypass grafting surgery. Ann Thorac Surg. 2005;79(3):807–12; discussion 12–3. doi: 10.1016/j.athoracsur.2004.06.013 15734382

31. Li XH, Xiao F, Zhang SY. [Investigation of risk factors of acute kidney injury after off-pump coronary artery bypass grafting and 3 years' follow-up]. Beijing Da Xue Xue Bao Yi Xue Ban. 2017;49(1):131–6. 28203019

32. Singh RS, Thingnam SKS, Mishra AK, Verma I, Kumar V. Renal function after off-pump versus on-pump coronary artery bypass grafting. Asian Cardiovasc Thorac Ann. 2017;25(7–8):504–8. doi: 10.1177/0218492317730256 28847152

33. Park J, Lee JH, Kim KA, Lee SH, Lee YT, Kim WS, et al. Effects of Preoperative Statin on Acute Kidney Injury After Off-Pump Coronary Artery Bypass Grafting. J Am Heart Assoc. 2019;8(7):e010892. doi: 10.1161/JAHA.118.010892 30905260

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2019 Číslo 10