CABG
induced AKI is fairly common.
Traditionally CABG is performed with bypass machine. Last decade has
noted a surge in doing CABG via an off pump method. So you can get a CABG
either off PUMP vs on PUMP. If the pump
is the problem and being on the bypass machine is what leads to the AKI, off
PUMP CABG should have less AKI?
What is the
data?
In 2010, a
meta-analysis published in CJASN showed that off-pump CABG may be associated with a lower incidence of
postoperative AKI but may not affect dialysis requirement, a serious
complication of cardiac surgery. However, the different definitions of AKI used
in individual trials and methodological concerns preclude definitive
conclusions.
Then in 2014, Garg’s group from Canada did a large study
looking at this question in the CORONARY study group in JAMA. They found that
the use of off-pump compared with on-pump CABG surgery reduced the risk of
postoperative acute kidney injury, without evidence of better preserved kidney
function with off-pump CABG surgery at 1 year.
Another meta-analysis in 2015 from the Mayo
clinic group showed a beneficial effect of off‐pump CABG on the incidence of
AKI. However, this meta‐analysis does not show benefits of the need of dialysis
or survival among patients undergoing off‐pump CABG.
In 2017, an Asian study published in Medicine found
that among the 3 surgical methods( off pump, on pump with arrest heart, on pump
with beating heart), off pump surgery resulted in lower AKI incidence. The
short term outcome, including kidney function, of on pump beating heart surgery
is similar to that of the off pump group.
The reasons
that are proposed for higher AKI in on-pump CABG patients include renal
hypoperfusion, hypotension, inflammation and oxidant stress. Compared to
on-pump surgery, off pump surgery has potential benefits of reduced AKI risk
and reduced cerebral dysfunction and reduced ICU stay and reduced mortality.
However,
KDIGO guideline suggests that “off pump CABG not be selected for the purpose of
reducing perioperative AKI or need for dialysis.”
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