Abstract
ObjectiveThe 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.MethodsBPS 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.Results964 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.ConclusionsIn 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-014-0196-3) contains supplementary material, which is available to authorized users.
Highlights
The use of cardiopulmonary bypass (CPB) in coronary artery bypass grafting (CABG) surgery affords the opportunity to achieve the most important goals of this operation ? complete revascularization, and performing the anastomoses in an ideal setting of bloodless and the use of CPB is associated with side-effects and complications inherent to the pathophysiology of this technology which involve a mechanical pump, bloodforeign surface interaction, blood-air interface and micro-? 2014 Shapira et al.; licensee BioMed Central
Secondary endpoints included rates of major complications including perioperative myocardial infarction, stroke, re-exploration for bleeding and sternal wound infection, time on the respirator and length of hospital and intensive-care unit stay. We focused on these endpoints to assess the safety of the biocompatible perfusion strategy (BPS), with regards to the risk of thromboembolic events secondary to low systemic anticoagulation
It reflects the typical profile of patients referred for CABG nowadays
Summary
? 2014 Shapira et al.; licensee BioMed Central The end results include systemic inflammatory response, coagulopathy and organ dysfunction [3] To attenuate these pathophysiological phenomena we and others developed a unique and comprehensive biocompatible perfusion strategy (BPS) in the mid 1990? S and have shown that this strategy is safe and associated with improved clinical outcomes in patients undergoing CABG, valve and aortic operations [4,5,6,7,8]. Patients often are referred in the setting of acute coronary syndrome on dual anti-platelet therapy and after one or more PCIs [10]
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