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