title: Hemoglobin Level to Facilitate Off-Pump Coronary Artery Bypass without Transfusion.
abstract: BACKGROUND
  Conservation of blood during cardiac surgery is important because of the shortage of donor blood, risks associated with transfusion, and the costs of allogeneic blood products. This retrospective study explored the feasibility of off-pump coronary artery bypass (OPCAB) without transfusion.
  
  
  METHODS
  One hundred and two consecutive patients underwent OPCAB from January 2007 to June 2012 at Hallym University Sacred Heart Hospital. Excluding 10 chronic renal failures patients, 102 patients were enrolled. Their characteristics, clinical data, and laboratory data were analyzed. We investigated the success rate of OPCAB without transfusion according to pre-operative hemoglobin (Hb), and the cutoff point of the Hb level and the risk factors for transfusion. We implemented multidisciplinary blood-saving protocols.
  
  
  RESULTS
  The overall operative mortality and the success rate of OPCAB without transfusion were 2.9% (3/102) and 73.5% (75/102). The success rates in patients with Hb<11, 11 <Hb<14, and 14<Hb were 35.0%, 79.2%, and 89.7% (p=0.01), respectively. The risk factors for transfusion are age>70 years, diagnosis of acute myocardial infarction, preoperative Hb and creatinine levels, and operation time. The events precipitating the need for transfusion were low Hb level in 9 patients and hypotension or excessive bleeding in 18 patients.
  
  
  CONCLUSIONS
  The preoperative Hb level of >11 facilitates OPCAB without transfusion. These results suggest that transfusion-free OPCAB can be performed by modifying the risk factors and correctable causes of transfusion and improving various blood salvage methods.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Hallym University College of Medicine.
authors.forename: Kun Il
authors.initials: KI
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Hallym University College of Medicine.
authors.forename: Won Yong
authors.initials: WY
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Hallym University College of Medicine.
authors.forename: Ho Hyun
authors.initials: HH
authors.lastname: Ko
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Hallym University College of Medicine.
authors.forename: Hyoung Soo
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Hallym University College of Medicine.
authors.forename: Jae Han
authors.initials: JH
authors.lastname: Jeong
keywords: Anemia; Blood transfusion; Off-pump coronary artery bypass