The University of Southampton
University of Southampton Institutional Repository

A prospective randomized study to evaluate the renoprotective action of beating heart coronary surgery in low risk patients

A prospective randomized study to evaluate the renoprotective action of beating heart coronary surgery in low risk patients
A prospective randomized study to evaluate the renoprotective action of beating heart coronary surgery in low risk patients
Objectives: cardiopulmonary bypass (CPB) is widely regarded as an important contributor to renal failure, a well recognized complication following coronary artery surgery (coronary artery bypass grafting (CABG)). Anecdotally off-pump coronary surgery (OPCAB) is considered renoprotective. We examine the extent of renal glomerular and tubular injury in low-risk patients undergoing either OPCAB or on-pump coronary artery bypass (ONCAB).
Methods: forty low-risk patients with normal preoperative cardiac and renal functions awaiting elective CABG were prospectively randomized into those undergoing OPCAB (n=20) and ONCAB (n=20). Glomerular and tubular injury were measured respectively by urinary excretion of microalbumin and retinol binding protein (RBP) indexed to creatinine (Cr). Daily measurements were taken from admission to postoperative day 5. Fluid balance, serum Cr and blood urea were also monitored.
Results: no mortality or renal complication were observed. Both groups had similar demographic makeup, Parsonnet score, functional status and extent of coronary revascularization (2.1±1.0 vs. 2.5±0.7 grafts; P=0.08). Serum Cr and blood urea remained normal in both groups throughout the study. A significant and similar rise in urinary RBP:Cr occurred in both groups peaking on day 1 (3183±2534 vs. 4035±4079; P=0.43) before reapproximating baseline levels. These trends were also observed with urinary microalbumin:Cr (5.05±2.66 vs. 6.77±5.76; P=0.22). Group B patients had a significantly more negative fluid balance on postoperative day 2 (?183±1118 vs. 637±847 ml; P=0.03).
Conclusions: although renal complication or serum markers of kidney dysfunction were absent, sensitive indicators revealed significant and similar injury to renal tubules and glomeruli following either OPCAB or ONCAB. These results suggest that avoidance of CPB does not offer additional renoprotection to patients at low risk of perioperative renal insult during CABG.
cardiopulmonary bypass, pulsatile flow, renal injury, off-pump, myocardial revascularization
1010-7940
118-123
Tang, A.T.M.
e03fc6de-f019-4ad6-b5f5-711c109f52d1
Knott, J.
6d026827-e4be-4d5a-a556-5aa76d960bbe
Nanson, J.
fa2d2ed5-949f-4d21-a6d8-09e78dcfac7a
Hsu, J.
e461e730-65b9-4fbd-a56e-a6499b9fd3df
Haw, M.P.
2b6001b8-3b36-4408-a185-322bbdd6e730
Ohri, S.K.
8aa5698c-78cf-4f59-a5af-5afa46f0348c
Tang, A.T.M.
e03fc6de-f019-4ad6-b5f5-711c109f52d1
Knott, J.
6d026827-e4be-4d5a-a556-5aa76d960bbe
Nanson, J.
fa2d2ed5-949f-4d21-a6d8-09e78dcfac7a
Hsu, J.
e461e730-65b9-4fbd-a56e-a6499b9fd3df
Haw, M.P.
2b6001b8-3b36-4408-a185-322bbdd6e730
Ohri, S.K.
8aa5698c-78cf-4f59-a5af-5afa46f0348c

Tang, A.T.M., Knott, J., Nanson, J., Hsu, J., Haw, M.P. and Ohri, S.K. (2002) A prospective randomized study to evaluate the renoprotective action of beating heart coronary surgery in low risk patients. European Journal of Cardio-thoracic Surgery, 22 (1), 118-123. (doi:10.1016/S1010-7940(02)00220-8).

Record type: Article

Abstract

Objectives: cardiopulmonary bypass (CPB) is widely regarded as an important contributor to renal failure, a well recognized complication following coronary artery surgery (coronary artery bypass grafting (CABG)). Anecdotally off-pump coronary surgery (OPCAB) is considered renoprotective. We examine the extent of renal glomerular and tubular injury in low-risk patients undergoing either OPCAB or on-pump coronary artery bypass (ONCAB).
Methods: forty low-risk patients with normal preoperative cardiac and renal functions awaiting elective CABG were prospectively randomized into those undergoing OPCAB (n=20) and ONCAB (n=20). Glomerular and tubular injury were measured respectively by urinary excretion of microalbumin and retinol binding protein (RBP) indexed to creatinine (Cr). Daily measurements were taken from admission to postoperative day 5. Fluid balance, serum Cr and blood urea were also monitored.
Results: no mortality or renal complication were observed. Both groups had similar demographic makeup, Parsonnet score, functional status and extent of coronary revascularization (2.1±1.0 vs. 2.5±0.7 grafts; P=0.08). Serum Cr and blood urea remained normal in both groups throughout the study. A significant and similar rise in urinary RBP:Cr occurred in both groups peaking on day 1 (3183±2534 vs. 4035±4079; P=0.43) before reapproximating baseline levels. These trends were also observed with urinary microalbumin:Cr (5.05±2.66 vs. 6.77±5.76; P=0.22). Group B patients had a significantly more negative fluid balance on postoperative day 2 (?183±1118 vs. 637±847 ml; P=0.03).
Conclusions: although renal complication or serum markers of kidney dysfunction were absent, sensitive indicators revealed significant and similar injury to renal tubules and glomeruli following either OPCAB or ONCAB. These results suggest that avoidance of CPB does not offer additional renoprotection to patients at low risk of perioperative renal insult during CABG.

This record has no associated files available for download.

More information

Published date: 2002
Keywords: cardiopulmonary bypass, pulsatile flow, renal injury, off-pump, myocardial revascularization

Identifiers

Local EPrints ID: 26013
URI: http://eprints.soton.ac.uk/id/eprint/26013
ISSN: 1010-7940
PURE UUID: 168772e3-6cfd-4bf4-875c-d0be058911f7

Catalogue record

Date deposited: 20 Apr 2006
Last modified: 16 Jul 2024 17:13

Export record

Altmetrics

Contributors

Author: A.T.M. Tang
Author: J. Knott
Author: J. Nanson
Author: J. Hsu
Author: M.P. Haw
Author: S.K. Ohri

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×