ABSTRACT 58

SERUM CREATININE LEVELS AND THE NEED FOR RENAL SUPPORT AFTER OFF-PUMP CORONARY ARTERY BYPASS SURGERY

Yousuf Mahomed, Palaniswamy Vijay, John W. Brown.  Indiana University School of Medicine, Indianapolis, IN

Several reports have suggested that elevated serum creatinine levels seen prior to conventional on-pump coronary bypass surgery leads to an increased need for renal support postoperatively.  We investigated the impact of serum creatinine on postoperative renal support in patients following off-pump coronary artery bypass surgery (OPCAB).

Patients (n=152, mean age 66±8y) undergoing OPCAB surgery (Octopus 2) were included in the study.  Based on their preoperative serum creatinine levels, the patients were divided into groups I (<1.5mg/dL, mean: 0.9±0.4, n=130), II (>1.5<3.0mg/dL, mean: 1.9±1.1, n=18) and III (>5.0mg/dL, mean: 5.5±0.5, n=4).  The patients were observed during their in-hospital stay (7±5days) and outcomes were obtained.

The postoperative course was uneventful in group I patients.  Group II and III patients had extended ventilation period (17±4 hr) compared to 10±2hrs in group I patients.  One patient each from group II (5%) and III required hemodialysis.  No patients in the study had stroke, and 3 patients from group II had increased postoperative bleeding.  The numbers of vessels grafted, operative time, ICU and hospital stay were not significantly different among patients.

Results indicate that OPCAB can markedly decrease the need for postoperative renal support in patients with elevated preoperative serum creatinine when compared to conventional on-pump bypass surgery.