title: The relationship between total arterial revascularization and blood transfusion following coronary artery bypass grafting.
abstract: BACKGROUND
  Blood transfusion adversely affects the outcome of coronary artery bypass grafting (CABG), yet blood transfusion after CABG is still common. Total arterial revascularisation (TAR) is increasingly used in current practice but its impact on postoperative blood transfusion is not known.
  
  
  METHODS
  We reviewed the cardiothoracic and blood bank databases and collected data for isolated primary CABG patients from July 2007 to June 2012, excluding patients who had a single graft (n = 148). Perioperative variables of TAR patients (n = 745) were compared with patients who had one or more venous grafts (SVG, n = 1,761) for first-time isolated CABG. The conduits used in TAR patients were predominantly left internal thoracic and radial arteries. Matched group comparison of TAR and SVG patients was performed. The association of TAR with blood transfusion was investigated using multivariate and matched analysis.
  
  
  RESULTS
  Of 2,506 patients, the 745 (29.7 %) that had TAR were generally younger, with less complex coronary artery disease and less often diabetic. After correcting for these by 1:1 matching, the mean chest tube drainage and rates of blood transfusion remained significantly lower (p < .0001) in TAR patients. Indeed, red cells, platelets and fresh frozen plasma were significantly less frequently transfused in TAR patients. By multivariate analysis, TAR had an independent effect on reducing blood transfusion after CABG [odds ratio (OR) 0.67, 95 % confidence interval (CI) 0.47-0.97, p = .03].
  
  
  CONCLUSIONS
  TAR achieved predominantly with left internal thoracic and radial arteries substantially reduced blood transfusion rates after primary CABG. Further studies are warranted.
authors.affiliation: The Essex Cardiothoracic Centre, Basildon University Hospital NHS Foundation Trust, Basildon, Essex, SS16 5NL, UK.
authors.forename: Jasmina
authors.initials: J
authors.lastname: Djordjevic
authors.forename: Dumbor L
authors.initials: DL
authors.lastname: Ngaage
mesh_terms: D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002305:Cardiac Tamponade / Q000209:etiology / Q000601:surgery; D015505:Chest Tubes; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery; D004322:Drainage; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000637:transplantation*; D012086:Reoperation; D012189:Retrospective Studies; D056346:Sternotomy