On-pump Versus Off-pump Coronary Bypass Surgery on Patients with Hemodialysis-Dependent Chronic Renal Failure

Abstract

Introduction: Coronary baypas surgery has more mortality and morbidity risks in patients with chronic renal failure than in individuals with normal functional kidneys. Therefore, the selection of the most helpful medical treatment and surgical technique are important for patient survival and surgical success of revascularization. Patients and Methods: Overall, 55 patients with hemodialysis-dependent chronic renal failure and who underwent open heart surgery were retrospectively studied. Of them, 36 (65.5%) were male and 19 (34.5%) were female, and the mean age was 61.2 ± 10.1 years (range, 34-83 years). Preoperative functional capacity was poor in 30% of patients, and 32 patients (58.2%) underwent complete revascularization and 23 patients (41.8%) underwent incomplete revascularization. Results: There was no statistical difference between the two surgical techniques in terms of mortality (p= 0.476), with 32% mortality in off-pump technique and 23.4% in on-pump technique. The complete revascularization procedure performed excess in the on-pump technique. Complete revascularization rates in on-pump technique was 86.7% and those in off-pump technique was 24%, having a significant difference (p< 0.001). Conclusion: Achieving complete revascularization should be the goal of coronary revascularization in patients with chronic renal failure. On-pump technique is important in complete revascularization procedure and intraoperative hemodialysis. Preoperative support treatment (including intraaortic balloon pump and inotropic support) must be used in patients with heart failure and in emergency surgeries because surgical results are affected by the preoperative functional capacity.