title: Clinical outcomes of on-pump coronary bypass using heparin-bonded circuits and reduced anti-coagulation compare favorably with off-pump approach.
abstract: Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB), or off pump, has gained popularity by avoiding the postoperative morbidity related to the use of CPB. Previously, we have demonstrated that CABG done on pump using heparin-bonded cardiopulmonary bypass circuits (HBC) with a lower anti-coagulation protocol (LAP) attenuates these effects, reduces homologous blood product requirement, and improves clinical outcome when compared with conventional CPB circuits. Our purpose in this study was to compare off-pump CABG clinical outcomes to on-pump CABG using HBC with LAP. We retrospectively analysed preoperative and postoperative variables of all primary CABG (n=1214) performed at this institution from 1 January 1997 to 28 July 2000. These patients were divided into the on-pump (n=1152) and off-pump groups (n=62). HBC with LAP were used in all on-pump CABG cases. There was no statistical difference in preoperative comorbid risk factors except percentage of females (on pump, 30% vs. off pump, 44%; p=0.02) and body surface area (on pump, 1.94 +/- 0.25 ml vs. off pump, 1.85 +/- 0.22 ml; p=0.02). There was no difference in intraoperative and postoperative complications, risk-adjusted mortality, total blood product usage, or length of stay. The mean number of distal anastomoses performed was significantly different (on pump, 3.5 +/- 0.82 vs. off pump 1.8 +/- 0.82; p < 0.001). Despite similar preoperative risk factors, clinical outcomes and homologous blood requirements were not statistically different between the off-pump and on-pump groups. These endpoints should not be the only criteria to justify performing off-pump CABG.
authors.affiliation: Boston Medical Center, Massachusetts 02118, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: O'Gara
authors.forename: Vijay
authors.initials: V
authors.lastname: Natarajan
authors.forename: Kevin
authors.initials: K
authors.lastname: Lilly
authors.forename: Ali
authors.initials: A
authors.lastname: Husain
authors.forename: Oz M
authors.initials: OM
authors.lastname: Shapira
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Shemin
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D020099:Coated Materials, Biocompatible / Q000737:chemistry*; D001026:Coronary Artery Bypass / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D006493:Heparin; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; D006493:Heparin