A comparison of bleeding and transfusion in patients who undergo coronary artery bypass grafting via sternotomy with and without cardiopulmonary bypass

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Abstract

Objective: To determine whether there is a difference between on-pump cardiopulmonary bypass (CABG) and off-pump coronary artery bypass grafting (OPCAB) without heparin reversal with regard to bleeding, transfusion requirements, and incidence of surgical re-exploration of the mediastinum.

Design: Retrospective chart review.

Setting: A large academic medical center.

Participants: Two hundred adult patients undergoing cardiac surgery.

Interventions: None.

Measurements and Main Results: One hundred CABG patients were compared with 100 OPCAB patients. Statistical significance was measured with P values of ≤0.05. The heparin was not reversed in the OPCAB patients. CABG patients received more intraoperative allogeneic red blood cells (median 250 mL v 0 mL, p = 0.002), intraoperative autotransfusion (IAT) (550 mL v 425 mL, p = 0.001), platelets (9% v 1%, p = 0.009), and less albumin (0 mL v 250 mL, p = 0.001) than OPCAB patients. Postoperatively, CABG patients were more likely to receive fresh-frozen plasma (19% v 8%, p = 0.03) and less likely to receive IAT than the OPCAB group. During the initial 4-hour postoperative period, OPCAB patients exhibited greater blood loss via chest tube (290 mL v 385 mL, p = 0.003); however, at 12 hours and 24 hours postoperatively, there was no statistical difference in blood loss between the 2 groups. There were no statistically significant differences in surgical re-exploration of the mediastinum between the CABG and OPCAB groups.

Conclusion: Despite not reversing the heparin at the end of the OPCAB surgery, OPCAB surgery was associated with an overall reduction in allogeneic transfusion requirements.

Section snippets

Methods

After institutional review board approval, a retrospective study was undertaken of (n = 100) on-pump and (n = 100) off-pump (OPCAB) operations performed by a single surgeon at a large medical center in the midwestern United States between February 1999 and February 2001. Parameters examined included packed red blood cells, fresh-frozen plasma, platelets, and cryoprecipitate administered during the first 72 hours perioperatively, time of administration, perioperative blood loss, chest tube

Results

Patient characteristics are summarized in Table 1. Groups differed with respect to patient age (median 66 v 74 years for CPB v OPCAB groups, respectively; p < 0.001), weight (84.5 v 79.9 kg, p = 0.019), body surface area (2.01 v 1.94 m2, p = 0.032), and creatinine (1.1 v 1.2 mg/dL, p = 0.022). The sex distribution and preoperative medications were comparable for the 2 groups with the exception of preoperative coumadin therapy, which was more prevalent in the OPCAB group (p = 0.035). Procedural

Discussion

This is the first study to show that despite not reversing heparin at the end of OPCAB surgery, OPCAB surgery was associated with an overall reduction in allogenic transfusion requirements. The study showed that intraoperative transfusion of allogeneic red blood cells, IAT, and platelets was greater in the group that underwent CPB than OPCAB. When postoperative requirements are also considered, this study further established that overall the CPB group received more FFP and IAT than the OPCAB

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Supported by Mayo Foundation for Medical Education and Research.

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