Thrombotic complications in beating heart operations.
BACKGROUND
Off-pump coronary artery operations have recently gained popularity among the community of cardiac surgeons. Because the use of cardiopulmonary bypass is avoided, full anticoagulation is generally not sought to decrease perioperative blood loss and transfusion needs. Traditionally, patients undergoing coronary artery bypass operations with cardiopulmonary bypass are not considered at risk of having venous or arterial thromboembolic complications, and prophylaxis is generally not recommended.


RESULTS
We have reviewed our experience with off-pump coronary bypass operations, focusing on thromboembolic complications with clinical manifestations, and compared these findings with our experience with cardiopulmonary bypass operations. In our series of 500 off-pump cases, thromboembolic complications occurred in 1%, causing death in 1 patient, whereas in a contemporary cohort of 1476 patients operated on with cardiopulmonary bypass, thromboembolic complications resulted in stroke in 0.5% of the cases. This difference did not reach statistical significance.


CONCLUSIONS
Thromboembolic complications in off-pump coronary bypass operations are comparable with those in cardiopulmonary bypass operations. Although the prevalence of this complication remains low, the associated morbidity should lead to reconsideration of prophylactic measures.
Cartier
R
R
Department of Cardiac Surgery, Montreal Heart Institute, 5000 Belanger St. East, Montreal, Quebec H1T 1C8, Canada. RC2910@aol.com
Robitaille
D
D
D000925:Anticoagulants / Q000008:administration & dosage; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000209:etiology; D013923:Thromboembolism / Q000209:etiology* / Q000517:prevention & control; D020246:Venous Thrombosis / Q000209:etiology
D000925:Anticoagulants; D006493:Heparin