Abstract

BackgroundAccumulating evidence consistently demonstrates that blood transfusion in cardiac surgery is related to decreased short- and long-term survival. We aimed to evaluate periprocedural blood loss and transfusion rates in elective, isolated total arterial coronary artery bypass grafting (CABG) using exclusively skeletonized bilateral internal mammary arteries (IMAs).MethodsWe identified 1011 consecutive patients with coronary artery disease who underwent CABG between 1/2007 and 12/2014. Of them, 595 patients who presented preoperative hemoglobin levels >9md/dl and underwent elective, isolated CABG for multi-vessel coronary artery disease were included in the study population. 419 patients (70.4%) received total arterial CABG using skeletonized bilateral IMAs, in 176 patients (29.6%) mixed CABG (single IMA & saphenous vein) was performed. Propensity score adjustment using 16 variables was applied to control for treatment effect.ResultsIn patients undergoing total arterial CABG, heterologous blood transfusion could be avoided in 87.8% of all cases. Propensity score adjusted results showed a significantly lower incidence of erythrocyte concentrate transfusion in patients undergoing total arterial CABG compared to mixed CABG (odds ratio 2.74, 95% confidence interval 1.38–5.43, P = 0.004). There were no statistically significant differences in the rates of thrombocyte concentrate (P = 0.39) and fresh frozen plasma transfusions (P = 0.07).ConclusionsIn this study, patients who underwent elective, isolated total arterial CABG using exclusively skeletonized bilateral IMAs showed reduced transfusion rates of erythrocyte concentrates compared to mixed CABG using a combination of single IMA and saphenous vein grafts. No evidence for a higher incidence of complications was found with a total arterial approach.

Highlights

  • Blood loss is still one of the most frequent and feared complications in cardiac surgery leading to the consumption of a significant proportion of all blood products worldwide [1]

  • Since there are currently no prospective trials examining blood product utilization in patients undergoing total arterial revascularization, the objective of this study was to evaluate transfusion rates in total arterial coronary artery bypass grafting (CABG) using exclusively skeletonized bilateral internal mammary arteries (BIMA) compared to mixed CABG using a composition of single internal mammary artery (SIMA) and saphenous veins (SV) conduits

  • No significant association with greater Erythrocyte concentrate (EC) transfusion rates was found with Acetylsalicylic acid (p = 0.76), Factor Xa inhibitors (p = 0.13) and GPIIb/IIIa inhibitors (p = 0.81). This present single-center study compares two different CABG strategies: total arterial CABG using BIMA and mixed CABG using a composition of SIMA and SV conduits, in relation to periprocedural blood loss

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Summary

Introduction

Blood loss is still one of the most frequent and feared complications in cardiac surgery leading to the consumption of a significant proportion of all blood products worldwide [1]. Accumulating evidence demonstrates that a liberal strategy of red-cell transfusion in cardiac surgery shows no apparent benefits but is rather related to decreased short- and long-term survival [6,7,8]. Even the transfusion of a single blood unit has been shown to increase mortality and the length of hospital stay after CABG [9] Results from both the Transfusion Requirements After Cardiac Surgery (TRACS) trial and the TRICS III Trial showed no inferiority of a restrictive transfusion strategy in cardiac surgery [10, 11] with respect to a composite outcome of death, stroke, myocardial infarction and acute renal failure. Accumulating evidence consistently demonstrates that blood transfusion in cardiac surgery is related to decreased short- and long-term survival. We aimed to evaluate periprocedural blood loss and transfusion rates in elective, isolated total arterial coronary artery bypass grafting (CABG) using exclusively skeletonized bilateral internal mammary arteries (IMAs)

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