On-Pump CABG Increases Mortality Risk in CKD Patients
On-pump coronary artery bypass grafting (CABG) is associated with a significantly higher risk of mortality and morbidities vs off-pump CABG in patients with severe chronic kidney disease (CKD), according to a recent study. This risk is especially attributable to a higher likelihood of cardiopulmonary bypass use soon after surgery.
For their study, the researchers assessed 321 patients with severe CKD who received either on-pump (n=118) or off-pump (n=203) CABG between 1997 and 2015. All patients included in the study were classified as having stage 4 or 5 CKD, defined by the National Kidney Foundation Classification as an estimated glomerular filtration rate below 30 ml/min/1.73 m2.
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Surgical outcomes between both groups were assessed. Results were adjusted in accordance with propensity scores, which were based on 30 baseline covariates.
A total of 186 patients died over the course of the study. Ultimately, the researchers determined that patients in the off-pump group had a significantly lower risk of early death, sternal wound infection, prolonged ventilation, and overall mortality, compared with those in the on-pump group. Two patients (1.0%) in the off-pump group experienced early mortality, compared with 11 patients (9.3%) in the on-pump group. Additionally, patients in the off-pump group demonstrated fewer distal anastomoses vs patients in the on-pump group. Landmark analysis indicated that cardiopulmonary bypass use was not associated with a higher risk of mortality after 1 year.
“The on-pump strategy for patients with severe chronic kidney disease was associated with a significantly higher risk of mortality and morbidities, which is particularly attributable to a greater risk of cardiopulmonary bypass use in the early postoperative period,” the researchers concluded. “The study result suggests that the off-pump strategy might be beneficial in performing coronary artery bypass grafting, despite potentially incomplete revascularization in this high-risk cohort.”
—Christina Vogt
Reference:
Kim HJ, Kim JB, Jung SH, Choo SJ, Lee JW, Chung CH. Coronary artery bypass grafting in patients with severe chronic kidney disease: a propensity score-weighted analysis on the impact of on-pump versus off-pump strategies [Published online September 11, 2017]. Eur J Cardio-Thorac Surg. https://doi.org/10.1093/ejcts/ezx288.