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Coronary artery bypass grafting surgery without the routine application of blood products: Is it feasible?
M Wilhelmi1, U Franke, T Cohnert
1Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany. wilhelmi@thg.mh-hannover.de
Insights
Routine fresh frozen plasma (FFP) administration is not necessary for coronary artery bypass grafting (CABG) surgery. Avoiding FFP during CABG does not increase blood loss or the need for blood products.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
Background:
- Fresh frozen plasma (FFP) is routinely used in cardiac surgery.
- The necessity of FFP in elective coronary artery bypass grafting (CABG) is questioned.
Purpose of the Study:
- To evaluate the feasibility of performing CABG without FFP administration.
- To compare outcomes of CABG with and without intraoperative FFP.
Main Methods:
- 120 patients undergoing CABG were divided into two groups: FFP (n=60) and control (n=60).
- The FFP group received 4 units of FFP intraoperatively.
- The control group did not receive FFP.
- Perioperative hematologic parameters, blood loss, and blood product administration were monitored.
Main Results:
- The FFP group required significantly more packed red blood cells (pRBC) intraoperatively and postoperatively.
- No significant differences were observed in hemoglobin or hematocrit levels between groups.
- Postoperative blood loss was similar in both the FFP and control groups.
Conclusions:
- Avoiding routine intraoperative FFP administration in CABG is feasible.
- FFP avoidance does not increase postoperative blood loss or the need for FFP.
- This suggests a potential to reduce FFP use in CABG procedures.
Objective:
Fresh frozen plasma (FFP) substitution is currently standard practise in cardiac surgery. In this study we investigate whether elective coronary artery bypass grafting (CABG) surgery is feasible without the administration of blood products compared to the substitution of fresh frozen plasma.
Patients And Methods:
From September 1997 to April 1998, 120 consecutive patients underwent CABG surgery at our institution. In the FFP group patients (n=60; men, n=43; women, n=17; mean age: 64+/-8.5 years) received 4 units of fresh frozen plasma (FFP) intraoperatively. In comparison, patients in the control group (n=60; men, n=44; women, n=16; mean age: 65+/-7.5 years) did not receive FFP. Main endpoints included perioperative hematologic parameters, blood loss, and the amount of blood products that were administered.
Results:
Intraoperatively, the substitution of packed red blood cells (pRBC) in the FFP group was significantly higher compared with the control group (0.63+/-0.94 units/patient vs. 0.12+/-0.38 units/patient, P=0.001). Postoperatively, patients in the FFP group required significantly more pRBC products than patients in the control group (0.78+/-1.09 vs. 0.42+/-0.77, P=0.024). There were no significant differences in hemoglobin (FFP group: 99+/-11.1 g/dl; control group: 105+/-13.5 g/dl) and hematocrit levels (FFP group: 30+/-3.39%; control group: 32+/-4%). Also, no significant differences regarding the postoperative blood loss was observed between groups (FFP group: 588+/-224 vs. control group: 576+/-272 ml/24 h).
Conclusions:
This study clearly demonstrates that the avoidance of routine intraoperative FFP administration does not lead to an increase in blood loss postoperatively compared to patients that received FFPs. Furthermore, we did not observe increased requirements for postoperative FFP infusion in patients that did not receive FFPs intraoperatively.
