Comparison between the impact of acute kidney injury after on-pump or off-pump coronary artery bypass grafting / 中华胸心血管外科杂志

ABSTRACT

Objective To compare the impact of cardiopulmonary coronary artery bypass grafting (CCABG) and offpump coronary artery bypass grafting(OPCABG) on the incidence of acute kidney injury(AKI),and assess the independent risk factors of AKI.Methods Data of the isolated CABG patients in our center from January 2009 to December 2017 were collected and analyzed.3 346 patients entered the study,including 2 275 in CCABG group and 1 071 in OPCABG group.To compare the impact of CCABG and OPCABG on the incidence of AKI,and to assess the independent risk factors of AKI after CABG by the logistics regression method.The following were excludepatients with long-term dialysis,patients with missing serum creatinine data,emergent cases and CABG combined with other cardiac procedures.Results AKI occurred in 427 patients in CCABG group(18.8％) and 176 patients in OPCABG group(16.4％),there were no differences(x2 =2.53,P =0.11).There were no differences of new onset of dialysis between CCABG group(35 cases,1.5％) and OPCABG group(12 cases,1.1％),x2 =0.64,P =0.42.Comparing with patients without AKI,those with AKI had a longer mechanical ventilation support time [(33.1 ± 17.5) h vs.(16.4 ± 10.7) h],ICU time [(37.5 ± 16.8) h vs.(2.8 ± 9.5) h] and ward time [(18.1 ±6.3)days vs.(10.3 ± 3.7)days],all P ＜ 0.01.Logistic regression analysis modeling showed hypertension,preoperative renal dysfunction,duration of cardiopulmonary bypass,low cardiac output syndrome,perioperative application of intra-aortic ballon pump(IABP),blood transfusion and postoperative body temperature above 38℃ within 3 days were independent risk factors of AKI.Conclusion AKI is a common complication after CABG.Comparing to CCABG,OPCABG is not associated with a significant low rate of AKI or dialysis.Hypertension,preoperative renal dysfunction,low cardiac output syndrome,perioperative application of IABP,blood transfusion and postoperative body temperature above 38℃ within 3 days were independent risk factors of AKI.