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Blood product use in cardiac revascularization: comparison of on- and off-pump techniques
N D Nader1, W Z Khadra, N T Reich
1Department of Anesthesia, State University of New York at Buffalo, and the Veterans' Administration Western New York Healthcare System, USA.
Insights
Off-pump coronary artery bypass grafting reduces perioperative bleeding and blood product use compared to on-pump surgery. This technique may lead to fewer complications associated with transfusions in cardiac revascularization procedures.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
Background:
- Coronary artery bypass grafting (CABG) is a common cardiac revascularization procedure.
- Cardiopulmonary bypass (CPB) is associated with potential complications like neurologic injury, hemodilution, and coagulopathy.
- On-pump CABG utilizes CPB, while off-pump CABG performs surgery on a beating heart.
Purpose of the Study:
- To compare perioperative bleeding and blood product utilization between on-pump and off-pump CABG.
- To evaluate the impact of CPB avoidance on patient outcomes during CABG.
Main Methods:
- Retrospective chart review of 126 patients undergoing CABG.
- Analysis of data from 66 off-pump and 60 on-pump CABG patients.
- Statistical comparison using unpaired Student's t-test.
Main Results:
- The off-pump group experienced significantly less perioperative bleeding (2312 mL vs. 3251 mL, p < 0.05).
- Fewer blood products were required in the off-pump group compared to the on-pump group.
- Hemoglobin and platelet levels decreased more in the conventional on-pump group.
Conclusions:
- Avoiding cardiopulmonary bypass during CABG reduces perioperative bleeding.
- Off-pump CABG leads to decreased use of blood products.
- Reduced blood product transfusion may result in fewer transfusion-related complications.
Background:
Cardiac revascularization on a beating heart avoids the side effects of cardiopulmonary bypass (eg, neurologic injury, hemodilution, and coagulopathy). We examined perioperative bleeding and use of blood products during coronary artery bypass grafting using either on-pump or off-pump techniques.
Method:
The charts of 126 patients who had coronary artery bypass grafting were reviewed. Data from 66 patients revascularized off pump and 60 patients with cardiopulmonary bypass (on pump) were analyzed using unpaired Student's t test.
Results:
Average age was 62.5 years in either group. More patients received heparin preoperatively in the off-pump group that resulted in mild elevation of preoperative partial thromboplastin time and activated clotting time (40.4 +/- 2.9 seconds and 150.1 +/- 5.3 seconds, respectively). However, the off-pump group had less perioperative (intraoperative or postoperative) bleeding (2312 +/- 212 mL versus 3251 +/- 155 mL, p < 0.05) and required fewer blood products compared with the on-pump group. Hemoglobin and platelets decreased more in the conventional on-pump group.
Conclusions:
Avoiding cardiopulmonary bypass decreases perioperative bleeding and, consequently, reduces the use of blood products after coronary artery bypass grafting, which might result in fewer transfusion-related complications.