title: Safety and efficacy of biocompatible perfusion strategy in a contemporary series of patients undergoing coronary artery bypass grafting - a two-center study.
abstract: OBJECTIVE
  The profile of patients referred for coronary artery bypass grafting (CABG) is continuously changing to include older patients with multiple comorbidities. We assessed the safety and efficacy of a biocompatible perfusion strategy (BPS) in a contemporary series of patients undergoing isolated CABG.
  
  
  METHODS
  BPS consisted of a membrane oxygenator, tip-to-tip closed-system heparin-bonded cardiopulmonary bypass circuits without a cardiotomy reservoir, low systemic anticoagulation (target ACT - 250-300 sec) using heparin titration curves, low prime volume, avoidance of systemic cooling, and routine use of cell saver and anti-fibrinolytics. Data were prospectively collected using the American Society of Thoracic Surgeons National Adult Cardiac Surgery Database definitions.
  
  
  RESULTS
  964 consecutive patients (mean age 66 ± 11 years, 83% male) undergoing CABG between 2008 and 2012 were enrolled. 30-day mortality was 1.4%. Rates of postoperative stroke, myocardial infarction, sternal infection and reoperation for bleeding were 0.9%, 1.3%, 1.9% and 4.2%, respectively. Average 24-hour chest tube drainage was 440 ± 280 ml. Blood products were used in 34% of patients (total donor exposure of 1.7 ± 4.7 units/patient). Predictors of hospital mortality in multivariable analysis were left main disease and preoperative treatment with anti-arrhythmic or immunosuppressive medications. Predictors of allogeneic blood transfusions included older age, small body surface area, female gender, increased serum creatinine, lower preoperative LVEF and hematocrit. Priority of surgery, dual antiplatelet therapy and cardiopulmonary bypass time were not predictors of adverse outcomes or blood transfusions.
  
  
  CONCLUSIONS
  In a contemporary cohort of patients undergoing CABG, the use of BPS is safe and effective. It is associated with excellent clinical outcomes and reduced allogeneic blood transfusions.
authors.affiliation: Department of Cardiothoracic Surgery, Hebrew University, Hadassah Medical Center, POB 12000, Ein-Kerem, Jerusalem, 91120, Israel. ozshapira@hadassah.org.il.
authors.forename: Oz M
authors.initials: OM
authors.lastname: Shapira
authors.affiliation: Department of Cardiothoracic Surgery, Hebrew University, Hadassah Medical Center, POB 12000, Ein-Kerem, Jerusalem, 91120, Israel. ramitk@hadassah.org.il.
authors.forename: Amit
authors.initials: A
authors.lastname: Korach
authors.affiliation: Department of Cardiac Surgery, University Hospital of Angers, Angers, France. rpinaud@chu-angers.fr.
authors.forename: Frederic
authors.initials: F
authors.lastname: Pinaud
authors.affiliation: Department of Cardiothoracic Surgery, Hebrew University, Hadassah Medical Center, POB 12000, Ein-Kerem, Jerusalem, 91120, Israel. abeerd-@hotmail.com.
authors.forename: Abeer
authors.initials: A
authors.lastname: Dabah
authors.affiliation: Department of Cardiothoracic Surgery, Hebrew University, Hadassah Medical Center, POB 12000, Ein-Kerem, Jerusalem, 91120, Israel. yusheng.bao@thechristhospital.com.
authors.forename: Yusheng
authors.initials: Y
authors.lastname: Bao
authors.affiliation: Department of Cardiac Surgery, University Hospital of Angers, Angers, France. jjcorbeau@chu-angers.fr.
authors.forename: Jean Jacques
authors.initials: JJ
authors.lastname: Corbeau
authors.affiliation: Department of Cardiac Surgery, University Hospital of Angers, Angers, France. jldebrux@chu-angers.fr.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: de Brux
authors.affiliation: Department of Cardiac Surgery, University Hospital of Angers, Angers, France. chbaufreton@chu-angers.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Baufreton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D001026:Coronary Artery Bypass; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D007557:Israel; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications; D016896:Treatment Outcome