Membandingkan Nilai Kreatinin Serum Pascaoperasi On- Pump Coronary Artery Bypass Graft dan Off-Pump Coronary Artery Bypass Graft pada Penyakit Jantung Koroner di RSUP H. Adam Malik Medan

Abstract

Introduction: Coronary artery disease (CAD) remains a major cause of morbidity and mortality, with coronary artery bypass grafting (CABG) as the standard revascularization therapy. Two main techniques are used: conventional CABG with cardiopulmonary bypass (On Pump) and off-pump CABG (Off Pump). On Pump may increase the risk of acute kidney injury (AKI) due to hemodilution, non-pulsatile flow, and systemic inflammation, whereas Off Pump is considered to reduce these complications. However, comparative evidence on postoperative renal outcomes remains limited in Indonesia. Objective: To compare postoperative serum creatinine levels, incidence of AKI, and need for hemodialysis between On Pump and Off Pump CABG in patients with normal preoperative renal function at the Integrated Heart Center, H. Adam Malik General Hospital, Medan. Method: This was a retrospective cohort study involving 60 CAD patients undergoing CABG in 2024. Thirty-two patients underwent On Pump and 28 underwent Off Pump. Inclusion criteria were elective CABG with preoperative serum creatinine ≤1.2 mg/dL. Exclusion criteria included prior renal disease, combined cardiac procedures, or incomplete records. Postoperative serum creatinine was measured on day 1 and day 2. AKI was classified using AKIN criteria. Statistical analysis was performed using SPSS v22, with p <0.05 considered significant. Result: Mean postoperative serum creatinine was slightly higher in the On Pump group (1.19 ± 0.41 mg/dL) than in the Off Pump group (1.05 ± 0.54 mg/dL), but the difference was not statistically significant (p = 0.268). No patients in either group developed AKI or required hemodialysis. Baseline demographic and clinical characteristics were comparable between groups. Conclusion: There was no significant difference in postoperative serum creatinine, incidence of AKI, or hemodialysis requirement between On Pump and Off Pump CABG in patients with preserved preoperative renal function. Both techniques demonstrated comparable renal safety profiles, suggesting that surgical approach selection may be guided by other clinical considerations in low-risk populations.