Clinical outcome of patients with and without renal impairment undergoing a minimally invasive LIMA-to-LAD bypass operation

• Published in: The Heart surgery forum Vol. 3; no. 4; p. 313
• Main Authors: Riess, F C, Moshar, S, Bader, R, Schofer, J, Löwer, C, Kremer, P, Bleese, N
• Format: Journal Article
• Language: English
• Published: United States 2000
• Subjects: Aged; Coronary Angiography; Coronary Disease - complications; Coronary Disease - diagnosis; Coronary Disease - surgery; Female; Follow-Up Studies; Graft Occlusion, Vascular - diagnostic imaging; Graft Survival; Humans; Internal Mammary-Coronary Artery Anastomosis - adverse effects; Internal Mammary-Coronary Artery Anastomosis - methods; Kidney Function Tests; Male; Middle Aged; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - methods; Reference Values; Renal Dialysis; Renal Insufficiency - complications; Renal Insufficiency - diagnosis; Renal Insufficiency - therapy; Risk Assessment; Treatment Outcome; Vascular Patency
• ISSN: 1098-3511; 1522-6662

Patients with renal impairment undergoing conventional coronary artery bypass grafting (CABG) have a significant risk of postoperative deterioration of kidney function. We investigated the outcome of patients with and without renal impairment treated by off-pump coronary artery surgery. From January 1997 until January 2000, 158 consecutive patients (mean age 63 +/- 9.8 years, 126 male, 32 female) underwent minimally LIMA-to-LAD bypass operations. The patients were divided into three groups: group I patients (n = 133) had a preoperative creatinine of < 1.3 mg/dL, group II patients (n = 21) had a creatinine of > 1.3 mg/dL, and patients of group III (n = 4) required chronic dialysis due to terminal kidney dysfunction. Monitoring of the blood creatinine was performed during the entire hospital stay. A postoperative angiogram was performed in 113 of the 158 patients. All operations were performed without intraoperative complications. Postoperative angiograms revealed a patent LIMA-to-LAD bypass in all but one patient, who demonstrated a dissection of the left internal mammary artery (LIMA) graft. Mean creatinine value on admission was 1.0 +/- 0.1 mg/dL in group I and 2.7 +/- 1.9 mg/dL in group II. The maximal postoperative creatinine value was 1.1 +/- 0.4 mg/dL in group I and 2.9 +/- 2.7 mg/dL in group II. Neither hemofiltration nor hemodialysis was necessary in any patient of group I or group II during the postoperative course. Minimally invasive LIMA-to-LAD bypass is a safe and effective procedure with low morbidity and no mortality in the first 158 patients. Preoperative renal impairment had no adverse effect on outcome or residual kidney function. Thus, higher doses of diuretics and hemofiltration/dialysis were not used, resulting in a cost reduction. Therefore, this approach may be worthwhile to consider in patients with significant renal impairment who have to undergo CABG.