On-pump CABG is associated with more renal desaturation and higher biomarker values for acute kidney injury than off-pump CABG



Introduction: Coronary artery bypass grafting (CABG) is frequently associated with impaired renal function, which is often attributed to cardiopulmonary bypass (CPB). “Off-pump” CABG surgery may avoid this complication. Neutrophil gelatinase associated lipocalin (NGAL) is a recently identifiedearly biomarker for acute kidney injury. We determined if there is a difference in peri-operative haemodynamics, renal tissue oxygenation (SrtO2) and kidney injury (determined
by NGAL) between on-and off-pump CABG surgery.

Methods: In this prospective, randomised trial, 60 patients undergoing CABG were included after local IRB approval and written informed consent. Mean arterial pressure (MAP) and near-infrared spectroscopy derived peripheral tissue oxygenation (SptO2, InSpectra, Hutchinson, thenar muscle) and SrtO2 (above the kidney, INVOS 5100, Covidien) were continuously recorded during surgery. Blood samples were taken during and after surgery for plasma NGAL analysis.

Results: Twenty-nine on- and thirty off-pump patients, with no difference in patient characteristics, were analysed. MAP and SptO2 were similar in both groups during surgery. However, SrtO2 was significantly more decreased in the on-pump group, the median (range) area under baseline SrtO2 was 698 (239-1980)% · min–1 in the on-pump (n = 17) vs. 233 (0-2956)% · min–1 in the off-pump group (n = 21), respectively. Additionally, onpump CABG resulted in significantly higher median (range) NGAL values than off-pump CABG, with 100 (49-212) ng · mL–1 vs. 71 (29-127) ng · mL–1 at the end of surgery and 121 (52-359) ng · mL–1 vs. 95 (41-155) ng · mL–1 6 hours after surgery. However, there was no change in creatinine levels and none of the patients required renal replacement therapy. 

Discussion: While systemic haemodynamics(MAP) and systemic tissue oxygenation (SptO2) were equal in both groups, SrtO2 was lower and postoperative NGAL values were higher in the on-pump group compared to
the off-pump group. CPB may therefore be associated with an increased risk of postoperative acute kidney injury and this complication may be predicted by.
Originele taal-2English
StatusPublished - jun.-2013
Evenement28th Annual Meeting of the European Association of Cardiothoracic Anaesthesiologists () - Barcelona, Spain
Duur: 6-jun.-20138-jun.-2013
Congresnummer: 28


Conference28th Annual Meeting of the European Association of Cardiothoracic Anaesthesiologists ()
Verkorte titelEACTA
Internet adres

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