Effect of one-stop hybrid coronary revascularization on postoperative renal function and bleeding: A comparison study with off-pump coronary artery bypass grafting surgery

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• 作者：Shan Zhou ; MD^a ; Zhongrong Fang ; MD^a ; Hui Xiong ; MD^b ; Shengshou Hu ; MD^b ; Bo Xu ; MD^c ; Lei Chen ; MD^a ; Weipeng Wang ; MD^a ; ^{wpwang63@hotmail.com" class="auth_mail}
• 关键词：AKI ; acute kidney injury ; HCR ; hybrid coronary revascularization ; ICU ; intensive care unit ; LAD ; left anterior descending coronary artery ; LIMA ; left internal mammary artery ; OPCABG ; off-pump coronary artery bypass grafting ; PCI ; percutaneous coronary intervention
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：May 2014
• 年：2014
• 卷：147
• 期：5
• 页码：1511-1516.e1
• 全文大小：237 K

文摘

Although 1-stop hybrid coronary revascularization offers potential benefits for selected patients with multivessel coronary artery disease, the exposure to contrast dye and potent antiplatelet drugs could increase the risk of postoperative acute kidney injury and coagulopathy. The goal of the present study was to compare the measures of renal function, postoperative bleeding, and transfusion requirements in patients undergoing hybrid revascularization compared with off-pump coronary artery bypass grafting (CABG).

Methods

We retrospectively analyzed the data from 141 consecutive patients who had undergone 1-stop hybrid coronary revascularization from June 2007 to January 2011. Propensity score matching with 141 off-pump CABG patients from our surgical database was performed for comparison. The change in renal function, cumulative chest tube drainage, and clinical outcome parameters were compared between the 2 groups.

Results

Compared with off-pump CABG, patients undergoing hybrid revascularization had significantly less chest tube drainage at 12 hours after surgery (P = .04) and for the total amount during the postoperative period (P < .001) and required fewer blood transfusions (P = .001). The hybrid group had a higher incidence of acute kidney injury, but this did not reach statistical significance (25.2% vs 17.6%, P = .13). The hybrid group required less inotropic and vasoactive support, had fewer respiratory complications, required a shorter time of mechanical support, and had a decreased length of intensive care unit stay.

Conclusions

Compared with off-pump CABG, 1-stop hybrid coronary revascularization was associated with benefits such as less postoperative bleeding and blood transfusion requirements without significantly increasing the additional risk of acute kidney injury.