Cardiovascular Journal of Africa: Vol 30 No 5 (October 2019)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 5, September/October 2019 AFRICA 275
Effects of cardiopulmonary bypass on dialysis-
dependent patients
Nursen Tanrıkulu, Baburhan Ozbek
Abstract
Background: End-stage renal disease is considered an inde-
pendent risk factor for early and late survival after coronary
artery bypass grafting.
Methods: We retrospectively analysed patients with dialysis-
dependent renal insufficiency who had undergone coronary
artery bypass surgery between 2010 and 2017. Patients who
were operated with the assistance of cardiopulmonary bypass
(ONCAB) were in group 1 and those operated with off-pump
coronary artery bypass surgery (OPCAB) were in group 2. We
compared peri-operative morbidity and mortality rates and
short-term results of the two groups.
Results: There were 74 patients in group 1 and 36 in group
2. Blood transfusion requirement, drainage, need for intra-
aortic balloon pump and duration of stay in intensive care
unit was statistically significantly higher in group 1 (p < 0.05).
Also, postoperative creatine kinase (CK) and creatine kinase-
muscle/brain (CKMB) values were statistically significantly
higher in group 1 (p = 0.003).
Conclusion: Coronary artery bypass grafting under ONCAB
was a potential risk for morbidity and mortality in patients
with end-stage renal disease. Performing OPCAB surgery may
improve postoperative outcomes and should be kept in mind
as a surgical option.
Keywords: cardiac surgery, cardiopulmonary bypass, dialysis,
renal insufficiency
Submitted 7/3/19, accepted 25/4/19
Published online 24/5/19
Cardiovasc J Afr 2019; 30: 275–278
DOI: 10.5830/CVJA-2019-023
Coronary artery disease is a common cause of mortality in
patients requiring dialysis, with a rate higher than 40%.1 On the
other hand, end-stage renal disease (ESRD) is considered an
independent risk factor for early and late survival after coronary
artery bypass grafting (CABG).2 Peri-operative mortality risk
increases from five to 20% in ESRD patients, which is almost
three-fold higher than in non-ESRD patients.3
Off-pump coronary artery bypass grafting (OPCAB) is a well-
established and feasible procedure with reduced morbidity and
mortality rates in high-risk patients.4,5 By contrast, some authors
reported that long-term survival rates after OPCAB were
worse than those of on-pump coronary artery bypass grafting
(ONCAB) because of lower rates of complete revascularisation.6
However, it was reported that OPCAB had better short-term
outcomes than conventional CABG in ESRD patients.6
There are limited data on myocardial revascularisation
procedures in patients withESRD. In this study, we retrospectively
analysed peri-operative and short-term outcomes of dialysis-
dependent patients after CABG and analysed the effect of
cardiopulmonary bypass on the outcomes.
Methods
Patients who had undergone coronary artery surgery from 1
January 2010 to 31 December 2017 in our department were
retrospectively analysed. We included patients with selective
CABG surgery and dialysis-dependent ESRD. We excluded
patients who had undergone a concomitant surgical procedure,
had dialysis-independent renal disease and patients younger than
18 years old. All demographics and peri-operative variables were
obtained from medical records.
Regarding the surgical procedure, patients were evaluated in
two groups. Group 1 consisted of patients who had undergone
ONCAB, and those who were operated with OPCAB were in
group 2.
All operations were performed via a median sternotomy.
Arterial conduits were harvested in a skeletonised fashion. In
group 1, heparin was given to achieve an activated clotting time
of 480 seconds. Standard cardiopulmonary bypass (CPB) was
achieved via cannulating the ascending aorta and right atrium.
Cold blood cardioplegia was delivered through the aortic root
(antegrade flow) and through the coronary sinus (retrograde
delivery). All patients were ultra-filtrated during CPB with a
mean volume removal of 1 500 ml.
In group 2, heparin was given to achieve an activated clotting
time greater than 300 seconds. Deep pericardial stitches were
placed to manipulate the heart and expose the coronary arteries.
An Octopus coronary stabiliser (Medtronic Inc, Minneapolis,
MN) was used. Distal anastomoses were done first and the
operation was ended after a proximal anastomosis. We compared
pre-operative demographics and peri-operative and short-term
outcomes between the two groups.
Statistical analysis
Statistical analyses were performed with the NCSS (Number
Cruncher Statistical System) 2007 Statistical Software (Utah,
USA) program for Windows. Besides standard descriptive
statistical calculations, the Mann–Whitney U-test was used for
comparison of the groups. The Wilcoxon test was employed in
the assessment of pre- and postoperative values. Chi-squared
Department of Anesthesiology, Kolan International
Hospital, Istanbul, Turkey
Nursen Tanrıkulu, MD
Department of Paediatric Cardiovascular Surgery, Van
Training and Research Hospital, Van, Turkey
Baburhan Ozbek, MD,