TY - JOUR
T1 - A comparison of bleeding and transfusion in patients who undergo coronary artery bypass grafting via sternotomy with and without cardiopulmonary bypass
AU - Nuttall, Gregory A.
AU - Erchul, Daniel T.
AU - Haight, Tamara J.
AU - Ringhofer, Stephen N.
AU - Miller, Treva L.
AU - Oliver, William C.
AU - Zehr, Kenton J.
AU - Schroeder, Darrell R.
N1 - Funding Information:
Supported by Mayo Foundation for Medical Education and Research.
PY - 2003/8
Y1 - 2003/8
N2 - 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.
AB - 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.
KW - Bleeding
KW - Cardiac surgery
KW - Cardiopulmonary bypass
KW - Off-pump coronary artery bypass (OPCAB)
KW - Surgical re-exploration
KW - Transfusion
UR - http://www.scopus.com/inward/record.url?scp=0042858160&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0042858160&partnerID=8YFLogxK
U2 - 10.1016/S1053-0770(03)00148-4
DO - 10.1016/S1053-0770(03)00148-4
M3 - Article
C2 - 12968231
AN - SCOPUS:0042858160
VL - 17
SP - 447
EP - 451
JO - Journal of Cardiothoracic and Vascular Anesthesia
JF - Journal of Cardiothoracic and Vascular Anesthesia
SN - 1053-0770
IS - 4
ER -