Clinical outcome of patients with and without renal impairment undergoing a minimally invasive LIMA-to-LAD bypass operation

PURPOSE: Patients with renal impairment undergoing conventional coronary ar tery bypass grafting (CABG) have a significant risk of postoperative deteri oration of kidney function. We investigated the outcome of patients with an d without renal impairment treated by off-pump coronary artery surgery. METHODS: From January 1997 until January 2000, 158 consecutive patients (me an age 63 +/- 9.8 years, 126 male, 32 female) underwent minimally LIMA-to-L AD bypass operations. The patients were divided into three groups: group I patients (n=133) had a preoperative creatinine of <1.3 mg/dL, group II pati ents (n=21) had a creatinine of greater than or equal to1.3 mg/dL, and pati ents of group III (n=4) required chronic dialysis due to terminal kidney dy sfunction. Monitoring of the blood creatinine was performed during the enti re hospital stay. A postoperative angiogram was performed in 113 of the 158 patients. RESULTS: All operations were performed without intraoperative complications . Postoperative angiograms revealed a patent LIMA-to-LAD bypass in all but one patient, who demonstrated a dissection of the left internal mammary art ery (LIMA) graft. Mean creatinine value on admission was 1.0 +/- 0.1 mg/dL in group I and 2.7 +/- 1.9 mg/dL in group II. The maximal postoperative cre atinine value was 1.1 +/- 0.4 mg/dL in group I and 2.9 +/- 2.7 mg/dL in gro up II. Neither hemofiltration nor hemodialysis was necessary in any patient of group I or group II during the postoperative course. CONCLUSION: Minimally invasive LIMA-to-LAD bypass is a safe and effective p rocedure with low morbidity and no mortality in the first 158 patients. Pre operative renal impairment had no adverse effect on outcome or residual kid ney function. Thus, higher doses of diuretics and hemofiltration/dialysis w ere not used, resulting in a cost reduction. Therefore, this approach may b e worthwhile to consider in patients with significant renal impairment who have to undergo CABG.