A comparison of bleeding and transfusion in patients who undergo coronary artery bypass grafting via sternotomy with and without cardiopulmonary bypass.
OBJECTIVE
To determine whether there is a difference between on-pump cardiopulmonary bypass (CABG) and off-pump coronary artery bypass grafting (OPCAB) without heparin reversal with regard to bleeding, transfusion requirements, and incidence of surgical re-exploration of the mediastinum.


METHODS
Retrospective chart review.


METHODS
A large academic medical center.


METHODS
Two hundred adult patients undergoing cardiac surgery.


METHODS
None.


RESULTS
One hundred CABG patients were compared with 100 OPCAB patients. Statistical significance was measured with P values of <or=0.05. The heparin was not reversed in the OPCAB patients. CABG patients received more intraoperative allogeneic red blood cells (median 250 mL v 0 mL, p = 0.002), intraoperative autotransfusion (IAT) (550 mL v 425 mL, p = 0.001), platelets (9% v 1%, p = 0.009), and less albumin (0 mL v 250 mL, p = 0.001) than OPCAB patients. Postoperatively, CABG patients were more likely to receive fresh-frozen plasma (19% v 8%, p = 0.03) and less likely to receive IAT than the OPCAB group. During the initial 4-hour postoperative period, OPCAB patients exhibited greater blood loss via chest tube (290 mL v 385 mL, p = 0.003); however, at 12 hours and 24 hours postoperatively, there was no statistical difference in blood loss between the 2 groups. There were no statistically significant differences in surgical re-exploration of the mediastinum between the CABG and OPCAB groups.


CONCLUSIONS
Despite not reversing the heparin at the end of the OPCAB surgery, OPCAB surgery was associated with an overall reduction in allogeneic transfusion requirements.
Nuttall
Gregory A
GA
Department of Anesthesiology and Cardiac Surgery, Mayo School of Health Sciences, Mayo Clinic, Rochester, MN 55905, USA. nuttall.gregory@mayo.edu
Erchul
Daniel T
DT
Haight
Tamara J
TJ
Ringhofer
Stephen N
SN
Miller
Treva L
TL
Oliver
William C
WC
Zehr
Kenton J
KJ
Schroeder
Darrell R
DR
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D016063:Blood Loss, Surgical; D002315:Cardiopulmonary Bypass; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000628:therapy; D003404:Creatinine / Q000097:blood; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007430:Intraoperative Care; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation; D008875:Middle Aged; D015999:Multivariate Analysis; D017713:Platelet Transfusion; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D012709:Serum Albumin / Q000187:drug effects / Q000378:metabolism; D013249:Sternum / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D015415:Biomarkers; D012709:Serum Albumin; D014859:Warfarin; D003404:Creatinine