Redo coronary artery bypass grafting on the beating heart and transfusion needs.
OBJECTIVE
Reoperative coronary artery bypass grafting is associated with significant morbidity and a difficult perioperative management; in particular, important bleeding is observed. Off pump technique may give specific advantages in redo coronary operations since it is associated to decreased interactions of blood with foreign surfaces. We investigated our 5-year database to evaluate the role of off pump technique in reducing transfusion needs.


METHODS
The present single centre case control study was carried out in a university tertiary care hospital on 132 consecutive patients undergoing reoperative coronary artery bypass grafting off pump (OP group, 41 patients) or with cardiopulmonary bypass (CPB group, 91 patients). Univariate and multivariate analysis were performed.


RESULTS
There was no preoperative difference between the 2 groups; mean number of grafts per patient differed between groups (OP: 1.4+/-0.7, CPB: 2.5+/-1.0). The frequency of patients transfused with blood products was significantly (P=0.004) higher in the CPB group (47.3%) than in the OP group (19.5%). The only independent predictors of transfusions, determined by stepwise multivariate logistic regression analysis, was the use of cardiopulmonary bypass (OR: 4.1, CI: 1.6 - 10.1), and female gender (OR: 7.0, CI: 2.1 - 16.1).


CONCLUSIONS
In our centre, off pump coronary surgery is associated with reduced transfusion of blood products.
Gerli
C
C
Department of Cardiovascular Anesthesia, IRCCS San Raffaele Hospital, Milan, Italy.
Mantovani
L
L
Franco
A
A
De Luca
M
M
Bergonzi
P C
PC
Boroli
F
F
Romano
A
A
Landoni
G
G
Zangrillo
A
A
D000368:Aged; D000758:Anesthesia; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D047549:Coronary Artery Bypass, Off-Pump; D016208:Databases, Factual; D005260:Female; D006321:Heart / Q000502:physiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012086:Reoperation; D012189:Retrospective Studies; D012737:Sex Factors