الفهرس 
On pump (Conventional) CABGOnly 14 pages are availabe for public view
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Abstract
Background: Acute kidney injury (AKI) represent one of the frequent and serious complications that may occur after CABG surgery this may lead to further substantial morbidity and mortality. So our objective in this study, to identify the incidence and all predictors of acute kidney injury with both on pump and off pump CABG and if there is a significant difference between the 2 groups on kidney function within 1st 48 hours post-operatively based on AKIN criteria or not.
Patient and Methods: We prospectively studied 74 adult consecutive patients scheduled for isolated CABG surgery during the period between June 2017 and February 2018.The patients were allocated in 2 groups where 37 patients in each group (group A-ONCAB) and (group B-OPCAB). Occurrence of postoperative AKI was defined as proposed by the AKIN criteria. Patient preoperative characteristics, as well as intraoperative, CPB, and postoperative management variables, were evaluated for association with AKI with logistic regression analysis. The model including all variables was assessed first to obtain the risk factors of postoperative AKI (with odds ratio > 1) in each group and those with significant (p-value) considered predictors on the other hand, ROC curve done for all independent numerical variables to determine the cut off value for each numerical predictor. All patients with history or evidence of AKI before surgery, prior kidney transplantation and patients with a baseline GFR <60 ml/min/1.73 m2 or those with ESRD with GFR <15 ml/min/1.73 m2, patients receiving chronic hemodialysis ,and patients planned for OPCAB that reverted to on pump due to haemodynamic instability were excluded from this study.
Results: AKIN stage 1 was occurred in 85% versus 91.7% among ONCAB group versus OPCAB group respectively. While, AKIN stage 2 was occurred in 15% versus 8.3% among ONCAB group versus OPCAB group respectively. No cases were complicated with AKIN stage 3 among both study groups. All complicated cases with postoperative AKI were recovered without need for dialysis. We also found postoperative Hb and Hct (≤8.3gm/dl and ≤26% respectively), postoperative cardiogenic shock (Stunning), postoperative use of diuretics, preoperative ACE-I or ARBs, total CPB Time (>80 min) and occurrence of intraoperative Acidosis represent the predictors of postoperative AKI among ONCAB group. While, the duration between C.A and operation (<9 days), occurrence of intraoperative hemodynamic instability, intraoperative use of diuretics and postoperative Hct (≤24%) represent the predictors of postoperative AKI among OPCAB group.
Conclusion: Although theoretical advantages of OPCAB surgery, our findings suggest that OPCAB surgery does not confer significant protection from postoperative renal dysfunction in low-risk patients. So, reduction in renal risk alone should not be used as an indication for OPCAB over ONCAB surgery.