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Published on: September 15, 2023
Hemoglobin trends in isolated coronary artery bypass grafting performed off-pump and with standard and mini circuits
Francesco Rosato1, Dario Bruzzone, Faisal H Cheema
1Department of Cardiovascular Surgery, S. Croce e Carle Hospital, Cuneo, Italy.
Insights
Minimally invasive extracorporeal circulation and off-pump surgery show similar, reduced hemodilution compared to traditional cardiopulmonary bypass during coronary artery bypass grafting.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Hematology
Background:
- Hemodilution monitoring at surgery's end offers limited insight into dynamic changes.
- Perioperative hemoglobin trends are crucial for understanding fluid shifts during cardiac procedures.
Purpose of the Study:
- To compare perioperative hemoglobin curves across three coronary artery bypass grafting techniques.
- To evaluate hemodilution patterns associated with minimized extracorporeal circulation, traditional cardiopulmonary bypass, and off-pump surgery.
Main Methods:
- Propensity score matching created three homogenous patient groups (n=50 each).
- Isolated coronary artery bypass grafting was performed using minimized extracorporeal circulation, traditional cardiopulmonary bypass, or off-pump techniques.
- Generalized linear mixed models analyzed perioperative hemoglobin trends.
Main Results:
- Minimized extracorporeal circulation and off-pump groups exhibited similar hemoglobin reduction (3.1% and 1.6%, respectively).
- Traditional cardiopulmonary bypass resulted in significantly greater hemoglobin reduction (16.0%).
- Standard cardiopulmonary bypass was the sole independent predictor of increased hemodilution, with a time-dependent effect.
Conclusions:
- Perioperative hemodilution is significantly less pronounced with minimized extracorporeal circulation and off-pump techniques compared to standard cardiopulmonary bypass.
- Minimized extracorporeal circulation offers a hemodilution profile comparable to off-pump surgery.
- Standard cardiopulmonary bypass demonstrates a more pronounced and time-dependent effect on hemodilution.
Abstract:
The comparison of hemodilution at the end of surgery is of limited use as it represents only a snapshot of a dynamic phenomenon. This study was undertaken to compare the perioperative hemoglobin curves of isolated coronary artery bypass grafting performed with minimized extracorporeal circulation, traditional cardiopulmonary bypass, and off-pump technique. The propensity score method was used to select three groups of patients, homogenous regarding preoperative and operative data, who underwent isolated coronary artery bypass grafting. A generalized linear mixed model was used for estimating differences in perioperative hemoglobin trends among groups. The three groups were each composed of 50 patients with no differences in demographic data, preoperative risk profile, preoperative hemoglobin, or type of surgery. There was no significant difference in major postoperative complications. The pattern of the hemodilution curves was similar in patients operated with mini-circuit and off-pump technique (P > 005). Mini-circuit led to a 3.1 ± 11.9% hemoglobin reduction, which was similar to the off-pump group (1.6 ± 8.9%, P = 0.99 at ANOVA) and significantly different from the standard extracorporeal circuit group (16.0 ± 10.3%, P < 0.001 at ANOVA). The generalized linear mixed model determined that the standard circuit was the only independent predictor for increased hemodilution. Its effect on hemodilution was time-dependent and the slope of the hemoglobin curve was more pronounced between systemic heparinization and the end of surgery. Perioperative hemoglobin trends of patients who underwent myocardial revascularization with mini-circuit were similar to those of off-pump surgery and significantly less pronounced than those of standard extracorporeal circulation.
