Reduced postoperative blood loss and transfusion requirement after beating-heart coronary operations: a prospective randomized study.

Abstract

OBJECTIVE:

Coronary artery bypass grafting on the beating heart through median sternotomy is a relatively new treatment, which allows multiple revascularization without the use of cardiopulmonary bypass. A prospective randomized study was designed to investigate the effect of coronary bypass with or without cardiopulmonary bypass on postoperative blood loss and transfusion requirement.

METHODS:

Two hundred patients with coronary artery disease were prospectively randomized to (1) on-pump treatment with conventional cardiopulmonary bypass and cardioplegic arrest and (2) off-pump treatment on the beating heart. Postoperative blood loss identified as total chest tube drainage, transfusion requirement, and related costs together with hematologic indices and clotting profiles were analyzed.

RESULTS:

There was no difference between the groups with respect to preoperative and intraoperative patient variables. The mean ratio of postoperative blood loss and 95% confidence interval between groups was 1.64 and 1.39 to 1.94, respectively, suggesting on average a postoperative blood loss 1.6 times higher in the on-pump group compared with the off-pump group. Seventy-seven patients in the off-pump group required no blood transfusion compared with only 48 in the on-pump group (P <.01). Furthermore, less than 5% of patients in the on-pump group required fresh frozen plasma and platelet transfusion compared with 30% and 25%, respectively, in the on-pump group (both P <.05). Mean transfusion cost per patient was higher in the on-pump compared with that in the off-pump group ($184.8 +/- $35.2 vs $21.47 +/- $6.9, P <.01).

CONCLUSIONS:

Coronary artery bypass grafting on the beating heart is associated with a significant reduction in postoperative blood loss, transfusion requirement, and transfusion-related cost when compared with conventional revascularization with cardiopulmonary bypass and cardioplegic arrest.

• Authors: R Ascione, S Williams, C T Lloyd, T Sundaramoorthi, A A Pitsis, G D Angelini
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 121 Issue 4 Pg. 689-96 (Apr 2001) ISSN: 0022-5223 [Print] United States
• PMID: 11279409 (Publication Type: Clinical Trial, Comparative Study, Evaluation Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Blood Transfusion (economics, statistics & numerical data)
• Cardiopulmonary Bypass (adverse effects, economics)
• Coronary Angiography
• Coronary Artery Bypass (economics, methods)
• Coronary Disease (diagnostic imaging, surgery)
• Cost-Benefit Analysis
• Heart Arrest, Induced (adverse effects, economics)
• Humans
• Postoperative Hemorrhage (etiology, prevention & control, therapy)
• Prognosis
• Prospective Studies