PURPOSE: Patients with end-stage renal disease (ESRD) are increasingly referred for coronary artery bypass graft (CABG) and their early outcome is less favorable. Off-pump CABG (OPCAB) has achieved encouraging results in high-risk patients. Therefore, we designed this retrospective study to test the hypothesis that OPCAB reduced surgical risks in dialysis patients.
METHODS: From January 2000 to December 2005, 294 patients who required hemodialysis regularly received isolated CABG at the Washington Hospital Center. Among them, 168 underwent OPCAB (off-pump group), and 126, CABG with cardiopulmonary bypass (CPB) (on-pump group). The in-hospital outcomes were analyzed. The Social Security Death Index was used to calculate the long-term survival of both groups.
RESULTS: The two groups were comparable in terms of preoperative characteristics. The Parsonnet's Bedside Score of the off-pump group was similar to that of the on-pump group (32.0 vs 32.0, p = 0.57). The in-hospital mortality of the off-pump group was significantly lower than that of the on-pump group (5.4% vs 11.9%, p = 0.04). Patients undergoing OPCAB received less red blood cell transfusion, and they were less likely to develop perioperative myocardial infarction (MI). Logistic regression analysis revealed that use of CPB independently predicted in-hospital mortality (p < 0.01, odds ratio = 5.0, 95% confidence interval: 1.78-13.85) and perioperative MI (p = 0.03, odds ratio = 5.1, 95% confidence interval: 1.18-22.40). Long-term survival of initial hospital survivors was not different at 2 years and 4 years period between the two groups in terms of long-term survival.
CONCLUSION: Our data suggest that OPCAB is more than a safe alternative to on-pump CABG in dialysis patients. Avoiding CPB results in substantial benefits on early postoperative recovery in this population.
CLINICAL IMPLICATIONS: Patients with dialysis undergoing CABG should be considered off-pump surgery.
DISCLOSURE: Xiumei Sun, No Financial Disclosure Information; No Product/Research Disclosure Information