Sellin Christian, Laube Sarah, Demianenko Volodymyr, Balan Robert, Dörge Hilmar, Benoehr Peter
Department of Cardiothoracic Surgery, Klinikum Fulda gAG, University Medicine Marburg, Campus Fulda, 36043 Fulda, Germany.
Department of Anaesthesiology, Klinikum Fulda gAG, University Medicine Marburg, Campus Fulda, 36043 Fulda, Germany.
J Clin Med. 2024 Sep 12;13(18):5418. doi: 10.3390/jcm13185418.
Renal dysfunction and acute renal failure after coronary artery bypass grafting (CABG) are among the main causes of increased mortality and morbidity. A sternum-sparing concept of minimally invasive total coronary revascularization via anterior minithoracotomy (TCRAT) was introduced with promising early and midterm outcomes in multivessel coronary artery disease. There are limited data regarding renal complications in patients undergoing the TCRAT technique. The present study analyzed renal outcomes in TCRAT compared to CABG via full median sternotomy (FS). We analyzed the records of 227 consecutive TCRAT patients (from September 2021 to June 2023) and 228 consecutive FS patients (from January 2017 to December 2018) who underwent nonemergent CABG. Following propensity score matching, preoperative baseline characteristics-including age, sex, diabetes mellitus, arterial hypertension, left ventricular ejection fraction, EuroSCORE II, preoperative serum creatinine, estimated glomerular filtration rate (eGFR), serum urea, and pre-existing chronic renal insufficiency-were comparable between the TCRAT (n = 170) and the FS group (n = 170). The examined postoperative renal parameters and complications were serum creatinine, eGFR, and serum urea on the first postoperative day. Moreover, serum creatinine, eGFR and serum urea at the time of discharge, postoperative ARF, and hemodialysis were investigated. Additionally, the duration of operation, CPB time, aortic cross-clamp time, ICU and hospital stay, ECMO support, rethoracotomy and in-hospital mortality were analyzed. The parameters were compared between groups using a Student's -test or Mann-Whitney U test. The duration of operation (332 ± 66 vs. 257 ± 61 min; < 0.05), CPB time (161 ± 40 vs. 116 ± 38 min; < 0.05), and aortic cross-clamp time (100 ± 31 vs. 76 ± 26; < 0.05) were longer in the TCRAT group. ICU (1.8 ± 2.2 vs. 2.9 ± 3.6 days; < 0.05) and hospital (10.4 ± 7.6 vs. 12.4 ± 7.5 days; < 0.05) stays were shorter in the TCRAT group. There were no differences between groups with regard to the renal parameters examined. Despite a prolonged duration of operation, CPB time, and aortic cross-clamp time when using the TCRAT technique, no increase in renal complications were found. In addition, ICU and hospital stays in the TCRAT group were shorter compared to CABG via full median sternotomy.
冠状动脉旁路移植术（CABG）后的肾功能不全和急性肾衰竭是死亡率和发病率增加的主要原因之一。通过前外侧小切口（TCRAT）进行的保留胸骨的微创全冠状动脉血运重建概念被引入，在多支冠状动脉疾病中取得了令人鼓舞的早期和中期结果。关于接受TCRAT技术的患者的肾脏并发症的数据有限。本研究分析了TCRAT与通过全正中胸骨切开术（FS）进行CABG相比的肾脏结局。我们分析了227例连续的TCRAT患者（2021年9月至2023年6月）和228例连续的FS患者（2017年1月至2018年12月）的记录，这些患者均接受了非急诊CABG。在倾向评分匹配后，术前基线特征，包括年龄、性别、糖尿病、动脉高血压、左心室射血分数、欧洲心脏手术风险评估系统II、术前血清肌酐、估计肾小球滤过率（eGFR）、血清尿素和既往慢性肾功能不全，在TCRAT组（n = 170）和FS组（n = 170）之间具有可比性。检查的术后肾脏参数和并发症包括术后第一天的血清肌酐、eGFR和血清尿素。此外，还研究了出院时的血清肌酐、eGFR和血清尿素、术后急性肾衰竭和血液透析情况。此外还分析了手术时间、体外循环时间、主动脉阻断时间、重症监护病房（ICU）和住院时间、体外膜肺氧合（ECMO）支持、再次开胸手术和住院死亡率。使用学生t检验或曼-惠特尼U检验对两组参数进行比较。TCRAT组的手术时间（332±66 vs. 257±61分钟；P<0.05）、体外循环时间（161±40 vs. 116±38分钟；P<0.05）和主动脉阻断时间（100±31 vs. 76±26；P<0.05）更长。TCRAT组的ICU住院时间（1.8±2.2 vs. 2.9±3.6天；P<0.05）和住院时间（10.4±7.6 vs. 12.4±7.5天；P<0.05）更短。在所检查的肾脏参数方面，两组之间没有差异。尽管使用TCRAT技术时手术时间、体外循环时间和主动脉阻断时间延长，但未发现肾脏并发症增加。此外，与通过全正中胸骨切开术进行的CABG相比，TCRAT组的ICU和住院时间更短。
