Transfusions and early outcomes in anaemic patients undergoing off- or on-pump coronary artery bypass grafting

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Critical Care Medicine

Background:

• Preoperative anemia is common in patients undergoing coronary artery bypass grafting (CABG).
• Both off-pump coronary artery bypass grafting (OPCAB) and on-pump coronary artery bypass grafting (ONCAB) are surgical options for CABG.
• The choice between OPCAB and ONCAB may influence transfusion requirements and early outcomes, particularly in anemic patients.

Purpose of the Study:

• To compare transfusion rates and early outcomes between OPCAB and ONCAB in patients with preoperative anemia.
• To evaluate the impact of surgical approach on morbidity and mortality in this patient population.

Main Methods:

• Retrospective comparison of 1621 consecutive patients with preoperative anemia undergoing OPCAB or ONCAB.
• Propensity score analysis with inverse probability of treatment weighting was used.
• Endpoints included transfusion rates, early morbidity (e.g., renal replacement therapy, wound infection, stroke), and mortality (30-day and 1-year).

Main Results:

• OPCAB was associated with significantly fewer transfusions and a lower risk of postoperative renal replacement therapy compared to ONCAB.
• Patients undergoing OPCAB had a higher risk of wound infections than those undergoing ONCAB.
• There were no significant differences in perioperative stroke risk or 30-day and 1-year mortality between the OPCAB and ONCAB groups.

Conclusions:

• Both OPCAB and ONCAB are feasible surgical approaches for patients with preoperative anemia, demonstrating similar early morbidity and mortality.
• OPCAB offers benefits in reduced transfusion needs and lower risk of renal replacement therapy, but carries an increased risk of wound infections.
• The choice of surgical technique should consider the trade-offs between transfusion avoidance, renal protection, and infection risk.