초록접수 현황
| 15F-225 | 구연 발표 |
Coronary Artery Bypass Grafting in Patients with Severe Chronic Kidney Disease: The Clinical Impacts of On-pump Vs. Off-pump Strategies
김호진, 김준범, 정성호, 주석중, 정철현, 이재원
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Background : The optimal surgical strategy regarding the use of cardiopulmonary bypass (CPB) during coronary artery bypass grafting (CABG) in patients with severe chronic kidney disease (CKD) remains controversial.
Methods : We evaluated consecutive 336 patients with severe CKD (aged 63.4±8.5 years, 238 males) undergoing elective isolated CABG (on-pump, n=151; off-pump, n=185) between 1997 and 2013. CKD was defined as severe for estimated glomerular filtration rate (eGFR) < 30ml/min per 1.73m2. The rates of adverse outcomes were compared with the use of propensity scores and inverse-probability-weighting to adjust treatment selection bias.
Results : Early death rates were 9.3% (n=14) in On-Pump CABG group and 1.1% (n=2) in Off-Pump group (P=0.001). The On-pump CABG group had a higher number of distal anastomosis compared with the Off-Pump group (On-Pump vs. Off-Pump; 2.9 ± 0.9 vs. 2.7 ± 1.0; P=0.014). The patients in the On-Pump CABG group showed more frequent early morbidities such as low cardiac output syndrome requiring mechanical circulatory support (P=0.025), stroke (P=0.008), bleeding (0.011) and prolonged ventilation (P<0.001), compared with the Off-Pump group. During the overall study period, 63 patients experienced major adverse cardiovascular events (MACE; myocardial infarction, repeat-revascularization, stroke and hospitalization for cardiovascular causes) and 199 patients died. After adjustment, the use of CPB was associated with an increased risk for all cause death (hazard ratio [HR], 1.36; 95% confidence interval [CI] 1.03-1.79; P=0.030) and composite of all-cause death and MACE (HR, 1.32; 95% CI 1.01-1.72; P=0.044).
Conclusion : The use of CPB in performing CABG on patients with severe CKD was associated with significantly increased early mortality and morbidities, as well as the increased risks for overall mortality and the composite of death and MACE.
Methods : We evaluated consecutive 336 patients with severe CKD (aged 63.4±8.5 years, 238 males) undergoing elective isolated CABG (on-pump, n=151; off-pump, n=185) between 1997 and 2013. CKD was defined as severe for estimated glomerular filtration rate (eGFR) < 30ml/min per 1.73m2. The rates of adverse outcomes were compared with the use of propensity scores and inverse-probability-weighting to adjust treatment selection bias.
Results : Early death rates were 9.3% (n=14) in On-Pump CABG group and 1.1% (n=2) in Off-Pump group (P=0.001). The On-pump CABG group had a higher number of distal anastomosis compared with the Off-Pump group (On-Pump vs. Off-Pump; 2.9 ± 0.9 vs. 2.7 ± 1.0; P=0.014). The patients in the On-Pump CABG group showed more frequent early morbidities such as low cardiac output syndrome requiring mechanical circulatory support (P=0.025), stroke (P=0.008), bleeding (0.011) and prolonged ventilation (P<0.001), compared with the Off-Pump group. During the overall study period, 63 patients experienced major adverse cardiovascular events (MACE; myocardial infarction, repeat-revascularization, stroke and hospitalization for cardiovascular causes) and 199 patients died. After adjustment, the use of CPB was associated with an increased risk for all cause death (hazard ratio [HR], 1.36; 95% confidence interval [CI] 1.03-1.79; P=0.030) and composite of all-cause death and MACE (HR, 1.32; 95% CI 1.01-1.72; P=0.044).
Conclusion : The use of CPB in performing CABG on patients with severe CKD was associated with significantly increased early mortality and morbidities, as well as the increased risks for overall mortality and the composite of death and MACE.
책임저자: 정철현
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
연락처 : 김호진, Tel: 010-4348-0927 , E-mail : rhonin.hojin@gmail.com
