Although the pathogenesis of
acute renal injury after cardiac surgery is multifactorial,
atherosclerosis of the ascending aorta and embolic burden are strong independent predictors. Use of the Symmetry aortic connector device (ACD) for proximal anastomosis of coronary grafts may reduce ascending aortic
atheroembolism. Therefore, we tested the hypothesis that
off-pump coronary artery bypass (OPCAB) surgery performed using an ACD is associated with less postoperative renal dysfunction compared with conventional OPCAB or on-pump
coronary artery bypass graft (CABG) surgery. Three-thousand-three-hundred consecutive patients undergoing non-emergent
aortocoronary bypass surgery were retrospectively divided into three groups by
surgical procedure; Group A: OPCAB with ACD (n = 124), Group B: standard OPCAB (n = 313), Group C: on-pump CABG (n = 2863). Postoperative peak fractional change in
creatinine compared with baseline was used as a measure of renal outcome. Multivariable analysis did not identify ACD use as an independent predictor of postoperative peak fractional change in
creatinine (P = 0.71), although the relationships of several known renal risk factors with postoperative peak fractional change in
creatinine were confirmed. We could not find evidence that OPCAB surgery using ACDs reduces
acute renal injury compared with standard OPCAB or CABG surgery.