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Comparison of early platelet activation in patients undergoing on-pump versus off-pump coronary artery bypass surgery
Andrea Ballotta1, Hisham Z Saleh, Hisham W El Baghdady
1Department of Cardiac Surgery and Critical Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. andrea.ballotta@libero.it
Insights
Off-pump coronary artery bypass surgery causes less platelet dysfunction than on-pump surgery. This may explain the reduced bleeding risk associated with the off-pump technique.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Platelet Physiology
Background:
- Cardiopulmonary bypass (CPB) is linked to platelet dysfunction and increased bleeding risk.
- Off-pump coronary artery bypass (OPCAB) surgery is hypothesized to mitigate CPB-induced platelet issues.
- The specific impact of OPCAB on platelet function requires further investigation.
Purpose of the Study:
- To compare the effects of on-pump versus off-pump coronary artery bypass grafting (CABG) on platelet function.
- To assess platelet count, activation markers, and aggregation post-surgery.
- To determine if OPCAB preserves platelet function better than traditional CABG.
Main Methods:
- Prospective evaluation of 60 patients undergoing CABG.
- 30 patients received on-pump CABG with cardioplegic arrest.
- 30 patients underwent OPCAB surgery.
- Platelet function tests were performed pre- and 2-hours post-procedure.
Main Results:
- On-pump CABG led to significant platelet dysfunction post-surgery.
- OPCAB also showed some platelet dysfunction, but to a lesser extent.
- Key markers like platelet count, P-selectin, and Annexin V-positive platelets were significantly better preserved in the OPCAB group compared to the on-pump group.
Conclusions:
- OPCAB surgery results in a significantly smaller decrease in platelet count and less platelet activation compared to on-pump CABG.
- These findings suggest OPCAB may preserve hemostasis and reduce bleeding risk.
- The preserved platelet function in OPCAB could be a key factor in its clinical benefits.
Objective:
Cardiopulmonary bypass has been shown to be associated with platelet dysfunction, which has a potential for increasing the risk of perioperative bleeding. Off-pump coronary artery bypass surgery is thought to avoid this deleterious effect of pump use on platelets. However, the influence of off-pump coronary artery bypass surgery on platelets has not been thoroughly studied.
Methods:
Accordingly, we evaluated 60 patients undergoing coronary artery bypass grafting prospectively using cardiopulmonary bypass and warm cardioplegic arrest (n = 30) or an off-pump technique (n = 30). Platelet function was evaluated before and 2 hours after coronary artery bypass grafting.
Results:
Among patients undergoing on-pump coronary artery bypass surgery, all studies of platelet function were significantly abnormal after surgical intervention compared with results before surgical intervention. Similarly, among patients undergoing off-pump coronary artery bypass surgery, evidence of platelet dysfunction after surgical intervention was noted, with a lower platelet count and a higher proportion of P-selectin- and Annexin V-positive platelets. However, compared with the preprocedural value, the postprocedural decrease in platelet count (78,200 x 10(3)/microL vs 103,000 x 10(3)/microL) and platelet aggregation (0.8% vs 10.9%) and increase in bleeding time (0 minutes vs +1.3 minutes), P-selectin-positive platelets (6.0% vs 9.1%), and Annexin V-positive platelets (1.7% vs 3.7%) were significantly lower in the off-pump coronary artery bypass surgery group compared with those in the on-pump coronary artery bypass surgery group, respectively.
Conclusions:
Early postoperative decrease in platelet count and increase in platelet activation occurs to a much lesser extent and does not alter bleeding time or adenosine diphosphate-induced platelet aggregation in patients undergoing off-pump coronary artery bypass surgery. This lack of significant effects on platelets might in part account for the potential decreased risk in bleeding and for the preserved hemostasis seen in patients undergoing off-pump coronary artery bypass surgery compared with those undergoing on-pump coronary artery bypass grafting surgery.
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