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Thrombotic complications in beating heart operations
1Department of Cardiac Surgery, Montreal Heart Institute, 5000 Belanger St. East, Montreal, Quebec H1T 1C8, Canada. RC2910@aol.com
Insights
Off-pump coronary artery bypass operations show similar thromboembolic complication rates to traditional cardiopulmonary bypass. Despite low prevalence, these events warrant reconsidering prophylactic measures for cardiac surgery patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Off-pump coronary artery bypass (CAB) surgery is increasingly popular, avoiding cardiopulmonary bypass (CPB).
- Reduced anticoagulation is common in off-pump CAB to minimize bleeding and transfusion needs.
- Historically, CAB with CPB patients were not considered high risk for thromboembolic events, negating prophylaxis.
Purpose of the Study:
- To evaluate the incidence of thromboembolic complications in off-pump coronary artery bypass (CAB) operations.
- To compare these complication rates with those in patients undergoing CAB with cardiopulmonary bypass (CPB).
Main Methods:
- Retrospective review of 500 off-pump CAB operations.
- Comparison with a cohort of 1476 patients who underwent CAB with CPB.
- Focus on clinically manifested thromboembolic complications.
Main Results:
- Thromboembolic complications occurred in 1% of off-pump CAB patients, with one death.
- In the CPB group, 0.5% experienced thromboembolic complications, specifically stroke.
- The observed difference in complication rates between the two groups was not statistically significant.
Conclusions:
- Thromboembolic complications are comparable between off-pump CAB and CAB with CPB.
- The low but significant morbidity associated with these events necessitates re-evaluation of prophylactic strategies.
Background:
Off-pump coronary artery operations have recently gained popularity among the community of cardiac surgeons. Because the use of cardiopulmonary bypass is avoided, full anticoagulation is generally not sought to decrease perioperative blood loss and transfusion needs. Traditionally, patients undergoing coronary artery bypass operations with cardiopulmonary bypass are not considered at risk of having venous or arterial thromboembolic complications, and prophylaxis is generally not recommended.
Methods And Results:
We have reviewed our experience with off-pump coronary bypass operations, focusing on thromboembolic complications with clinical manifestations, and compared these findings with our experience with cardiopulmonary bypass operations. In our series of 500 off-pump cases, thromboembolic complications occurred in 1%, causing death in 1 patient, whereas in a contemporary cohort of 1476 patients operated on with cardiopulmonary bypass, thromboembolic complications resulted in stroke in 0.5% of the cases. This difference did not reach statistical significance.
Conclusions:
Thromboembolic complications in off-pump coronary bypass operations are comparable with those in cardiopulmonary bypass operations. Although the prevalence of this complication remains low, the associated morbidity should lead to reconsideration of prophylactic measures.