Document Detail


Clinical outcomes of on-pump coronary bypass using heparin-bonded circuits and reduced anti-coagulation compare favorably with off-pump approach.
MedLine Citation:
PMID:  11958309     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB), or off pump, has gained popularity by avoiding the postoperative morbidity related to the use of CPB. Previously, we have demonstrated that CABG done on pump using heparin-bonded cardiopulmonary bypass circuits (HBC) with a lower anti-coagulation protocol (LAP) attenuates these effects, reduces homologous blood product requirement, and improves clinical outcome when compared with conventional CPB circuits. Our purpose in this study was to compare off-pump CABG clinical outcomes to on-pump CABG using HBC with LAP. We retrospectively analysed preoperative and postoperative variables of all primary CABG (n=1214) performed at this institution from 1 January 1997 to 28 July 2000. These patients were divided into the on-pump (n=1152) and off-pump groups (n=62). HBC with LAP were used in all on-pump CABG cases. There was no statistical difference in preoperative comorbid risk factors except percentage of females (on pump, 30% vs. off pump, 44%; p=0.02) and body surface area (on pump, 1.94 +/- 0.25 ml vs. off pump, 1.85 +/- 0.22 ml; p=0.02). There was no difference in intraoperative and postoperative complications, risk-adjusted mortality, total blood product usage, or length of stay. The mean number of distal anastomoses performed was significantly different (on pump, 3.5 +/- 0.82 vs. off pump 1.8 +/- 0.82; p < 0.001). Despite similar preoperative risk factors, clinical outcomes and homologous blood requirements were not statistically different between the off-pump and on-pump groups. These endpoints should not be the only criteria to justify performing off-pump CABG.
Authors:
Paul J O'Gara; Vijay Natarajan; Kevin Lilly; Ali Husain; Oz M Shapira; Richard J Shemin
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Perfusion     Volume:  17     ISSN:  0267-6591     ISO Abbreviation:  Perfusion     Publication Date:  2002 Mar 
Date Detail:
Created Date:  2002-04-17     Completed Date:  2003-07-24     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8700166     Medline TA:  Perfusion     Country:  England    
Other Details:
Languages:  eng     Pagination:  91-4     Citation Subset:  IM    
Affiliation:
Boston Medical Center, Massachusetts 02118, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anticoagulants / administration & dosage
Coated Materials, Biocompatible / chemistry*
Coronary Artery Bypass / instrumentation,  methods*,  mortality
Female
Heparin*
Hospital Mortality
Humans
Male
Middle Aged
Perfusion / instrumentation,  methods
Retrospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Coated Materials, Biocompatible; 9005-49-6/Heparin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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