Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Clinical Surgical Research Center, Chiang Mai University, Chiang Mai, Thailand.
J Cardiothorac Surg. 2022 Aug 31;17(1):219. doi: 10.1186/s13019-022-01976-7.
In chronic kidney disease (CKD), using cardiopulmonary bypass (CPB) may contribute to renal dysfunction. Off-pump coronary artery bypass grafting (OPCAB) is one technique that preserved renal function, but the procedure may not be possible in certain situations. The ultrafiltration (UF) can remove excess fluid and inflammatory mediators that result from exposure to the CPB. Coronary artery bypass grafting (CABG) with UF could be an alternative way to preserve renal function.
A retrospective study of CKD patients who underwent CABG. The renal outcomes were compared between the patients who underwent CABG with UF and OPCAB. A repeated measure adjusted by propensity score was used for comparing the renal outcome. Univariable and multivariable logistic regression was used to identify the risk factors for acute renal failure (AKI) and adverse outcomes.
From January 2009 and June 2020, there were 220 CKD patients, 109 (49.55%) patients underwent CABG with UF, and 111 (50.45%) patients underwent OPCAB. There were statistically significant differences in the change of the average level of creatinine between CABG with UF (increased + 0.09 mg/dl) and OPCAB (decreased - 0.05 mg/dl) (p = 0.043). Also, patients who underwent CABG with UF had a significantly increased risk for AKI (OR 5.38, 95%CI 1.09, 26.5).
The UF adjunct technique in CABG with CPB tends to provide a lower protective effect for renal function and had a significantly higher incidence of post-cardiac surgery AKI when compared to OPCAB. If technically feasible, OPCAB would be a preferable choice for CKD patients.
SUR-2562-06607/Research ID: 6607.
在慢性肾脏病（CKD）中，使用体外循环（CPB）可能导致肾功能障碍。非体外循环冠状动脉旁路移植术（OPCAB）是一种保留肾功能的技术，但在某些情况下可能无法进行该手术。超滤（UF）可以去除因暴露于 CPB 而产生的多余液体和炎症介质。UF 辅助的冠状动脉旁路移植术（CABG）可能是一种保留肾功能的替代方法。
对接受 CABG 的 CKD 患者进行回顾性研究。比较了接受 UF 辅助 CABG 和 OPCAB 的患者的肾脏结局。采用倾向评分调整重复测量的方法比较肾脏结局。采用单变量和多变量逻辑回归分析确定急性肾损伤（AKI）和不良结局的危险因素。
2009 年 1 月至 2020 年 6 月，共有 220 例 CKD 患者，其中 109 例（49.55%）患者接受 UF 辅助 CABG，111 例（50.45%）患者接受 OPCAB。UF 辅助 CABG（增加 0.09mg/dl）与 OPCAB（减少 0.05mg/dl）之间肌酐平均水平的变化存在统计学显著差异（p=0.043）。此外，接受 UF 辅助 CABG 的患者发生 AKI 的风险显著增加（OR 5.38，95%CI 1.09，26.5）。
与 OPCAB 相比，CPB 辅助 CABG 中的 UF 辅助技术对肾功能的保护作用较低，并且术后 AKI 的发生率显著增加。如果技术可行，OPCAB 是 CKD 患者的首选。
SUR-2562-06607/研究 ID：6607。
