Off-pump coronary artery bypass grafting using continuous heparin infusion

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Pharmacology

Background:

• Anticoagulation management during off-pump coronary artery bypass grafting (OPCAB) is critical but challenging.
• Maintaining optimal activated clotting time (ACT) levels is difficult, with risks of both bleeding and thrombosis.
• Current methods using bolus heparin doses can lead to unpredictable ACT fluctuations.

Purpose of the Study:

• To evaluate the efficacy and safety of continuous heparin infusion for maintaining a steady, low target ACT during OPCAB.
• To compare this method with traditional anticoagulation strategies.

Main Methods:

• A prospective study involving consecutive OPCAB patients.
• Initial heparin bolus followed by continuous heparin infusion to maintain a target ACT.
• Monitoring of ACT and creatine kinase-MB (CPK-MB) levels to assess anticoagulation and ischemic complications.

Main Results:

• Heparin infusion successfully maintained the target ACT range in 80.1% of patients.
• Most deviations from the target ACT were managed by adjusting infusion rates, with minimal need for additional boluses.
• No increase in ischemic complications was observed.

Conclusions:

• Continuous heparin infusion provides a stable and predictable ACT level during OPCAB, avoiding the "peaks and troughs" of bolus dosing.
• This method is a safe anticoagulation strategy for OPCAB, without increasing the risk of myocardial infarction.
• This study represents the first investigation into heparin infusion for anticoagulation during OPCAB.