Surgical Re-exploration For Bleeding Research Articles

An off-pump biatrial mini-maze procedure for long-standing persistent atrial fibrillation.

The goal of the present study was to determine the safety and efficacy of a modified off-pump biatrial mini-maze procedure to treat long-standing persistent atrial fibrillation (AF). Patients with long-standing persistent AF underwent our modified mini-maze procedure using bipolar radiofrequency ablation. Those patients first underwent a mini-maze procedure using the Dallas lesion set protocol. Second, a purse-string suture was performed on the right atrium, and then 4 ablation lesions were made to the superior vena cava, the inferior vena cava, the appendix of the right atrium and the tricuspid valve annulus from the purse-string suture point by the bipolar radiofrequency clamp. After the operation, the patients were followed up at 3, 6 and 12 months and every year thereafter. A total of 102 patients were included in the study. There were no deaths, no surgical re-exploration for bleeding and no permanent pacemaker implants. The intraoperative cardioversion rate was 42.2% (43/102). A follow-up at intervals of 3, 6, 12, 24, 36 and 48 months showed that a success rate free from long-standing persistent AF was 95.1% (97/102), 94.4% (85/90), 94.8% (73/77), 91.5% (54/59), 90.3% (28/31) and 86.4% (19/22), whereas freedom from AF in patients off antiarrhythmic drugs was 88.2% (90/102), 85.6% (77/90), 81.8% (63/77), 78.0% (46/59), 74.2% (23/31) and 68.2% (15/22), respectively. The modified biatrial mini-maze procedure proved to be safe and feasible. Early follow-up demonstrated an acceptable success rate free from AF.

Transversal Arch Clamping for Complete Resection of Aneurysms of the Distal Ascending Aorta without Open Anastomosis.

Background: The extent of aortic replacement for aneurysms of the distal ascending aorta remains controversial and opinions vary between standard cross-clamp resection and open hemiarch anastomosis in circulatory arrest and selective cerebral perfusion. As the deleterious effects of extended circulatory arrest are well-known, borderline indication for distal ascending aorta aneurysm repair must be outweighed against the potential risk of complications related to the open anastomosis. In the present study, we describe our own approach consisting of “transversal arch clamping” for exhaustive resection of aneurysms of the distal ascending aorta without open anastomosis and we present the postoperative outcomes. Methods: Between May 2017 and December 2019, 35 patients with aneurysm of the ascending aorta (20 male, 15 female) underwent replacement with repair of the lesser curvature without circulatory arrest. Pre-operative, intraoperative, and postoperative clinical outcomes were retrospectively withdrawn from our institutional database and analyzed. Results: Maximal diameter of distal ascending aorta was 47.5 mm. Patient median age was 66 years (IQR 14) (range 42–86). Preoperative logistic median EuroSCORE II was 17% (IQR 11.3). Median duration of cardiopulmonary bypass and cardiac arrest were 137 (IQR 64) and 93 (IQR 59) min, respectively. In-hospital and 30-day mortality were 0%. There were no cases with acute low output syndrome, surgical re-exploration for bleeding, kidney injury requiring dialysis, or wound infection. Disabling stroke was observed in one patient (2.9%). There was one case of major ventricular arrhythmia (2.9%). Conclusions: Our institutional experience suggests that this novel technique is safe and feasible. It facilitates complete resection of the aortic ascending aneurysm avoiding circulatory arrest, antegrade cerebral perfusion, additional peripheral cannulation, and all related complications.

An off-pump biatrial mini-maze procedure for treatment of long-standing persistent atrial fibrillation

Abstract Background Surgical treatment has assumed a more prominent role in the therapy of atrial fibrillation (AF) with favorable efficiency and acceptable safety during the last decades. The traditional Cox-Maze procedure and Wolf Mini-Maze procedure focused on left atrial ablation. However, it is ubiquitous that patients with long-standing persistent atrial fibrillation (LSPAF) typically suffer from biatrial electrical and structural remodeling. The left atrial procedures are still not enough in patients with LSPAF. Purpose Herein, we aimed to introduce a modified biatrial off-pump ablation procedure based on the Wolf Mini-Maze procedure and to detect the safety and efficacy of the surgery for patients with LSPAF. Methods Between January 2016 and September 2020, 102 patients of LSPAF underwent our modified Mini-Maze procedure using bipolar radiofrequency ablation. Those patients firstly underwent a Mini-Maze procedure using Dallas lesion set, including video-assisted bilateral mini-thoracotomy, left atrial appendage excision, bilateral pulmonary vein isolation, ganglionic plexi evaluation and destruction, left atrial roof connecting lesion, and a linear lesion connecting this roofline to the root of the aorta at the junction of the left coronary and the non-coronary cusp. Secondly, a purse-string suture was performed on the right atrium, and then four ablation lesions were made to the superior vena cava, to the inferior vena cava, to the appendix of the right atrium, and to the tricuspid valve annulus from the purse-string suture point by the bipolar radiofrequency clamp. After the operation, the patients were followed up at an interval of 3, 6, 12 months, and every 1 year after that. Results No mortality No surgical re-exploration for bleeding. No permanent pacemaker implantation. 99 patients were free from LSPAF upon discharge. A follow-up at interval of 3, 6, 12, 24, 36, and 48 months showed a success rate free from LSPAF was 95.1% (97/102), 94.4% (85/90), 94.8% (73/77), 91.5% (54/59), 90.3% (28/31) and 100% (9/9), respectively Conclusions The modified biatrial Mini-Maze suggested a safe and feasible procedure. Early follow-up demonstrated an acceptable success rate free from AF. It might have the potential to become another option for clinical treatment of LSPAF. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): General Program of the National Natural Science Foundation of China Schematic of the procedure

Early Results after Lung Transplantation in Patients Bridged with Extracorporeal Life Support: Experience from a 7-year Period

Purpose Extracorporeal life support (ECLS) is being increasingly used in selected patients with end-stage pulmonary disease as a bridge to transplantation (BTT). In this study, we present our experience using preoperative ECLS in lung transplantation (LTx) and evaluate its impact on early outcome and survival. Methods We have performed a single-center retrospective analysis of all adult patients who were consecutively bridged to LTx using ECLS at Harefield Hospital between January 2012 and December 2018. Data were extracted from our institutional electronic medical records. Patients’ preoperative characteristics, use of perioperative ECLS, early postoperative results and in-hospital complications were analysed. Primary endpoint was 30-day mortality. Secondary endpoints were early postoperative outcomes. Results In total, 28 LTx recipients (53.6% males, mean age 32.6±10.6 years) were bridged to bilateral sequential single LTx with ECLS. The most common diagnoses were cystic fibrosis (75%), pulmonary artery hypertension (10.7%), fibrotic lung disease (7.1%), alpha-1 antitrypsin deficiency (3.6%) and others (3.6%). ECLS strategies included venovenous (VV) extracorporeal membrane oxygenation (ECMO; 71.4%), venoarterial (VA) ECMO (17.9%) and Novalung Interventional Lung Assist (iLA) device (10.7%). Median duration of bridging was 6 (range 2-53) days. Sixteen (57.1%) patients were awake and nonintubated during ECLS. Intraoperatively, 13 patients (46.4%) required cardiopulmonary bypass. Eleven patients stayed on VV ECMO, one on VA ECMO and 3 were converted to VA ECMO. Postoperatively, ECLS was utilized in 15 (53.6%) patients (6 VA ECMO/7 VV ECMO/2 Novalung). 30-day mortality was 21.4%. Median intensive care unit stay after LTx was 20 days. We have observed a delayed chest closure in 9 (32.1%) patients, surgical re-exploration for bleeding in 12 (42.9%) and renal failure requiring renal replacement therapy in 18 (64.3%). Conclusion We have performed a descriptive analysis of early postoperative outcomes of LTx in patients bridge with ECLS in a tertiary center over a 7-year period. Overall, we have demonstrated that, even if associated with high rate of early postoperative complications, ECLS as a BTT can be successfully used in selected patients with end-stage respiratory failure in a high-urgency setting.

Thromboelastography During Rewarming for Management of Pediatric Cardiac Surgery Patients

BackgroundThromboelastography (TEG) predicts bleeding in pediatric patients undergoing cardiac surgical procedure. We hypothesize that TEG indicators at rewarming correlate with postprotamine values and that rewarming TEG is associated with surrogate end points for postoperative bleeding in pediatric patients undergoing complex cardiac surgical procedure. MethodsIn a retrospective study of 703 pediatric (≤18 years) patients undergoing complex cardiac surgical procedures, TEG results obtained during rewarming and after protamine administration were compared using linear regression. A composite end point of extended blood product transfusion or surgical reexploration for bleeding was used as a surrogate for postoperative bleeding. ResultsBy multivariable analysis, longer cardiopulmonary bypass time and lower TEG maximal amplitude (MA) during rewarming were independently associated with the risk of the composite end point in the operating room or in the intensive care unit (P < .05). Among patients with an MA of less than 45 mm during rewarming, those who received a platelet transfusion in the operating room compared with those who did not were less likely to reach the composite end point within the subsequent 24 hours (8% vs 32%, respectively; P < .01). Good correlation was observed between TEG variables at rewarming vs after protamine administration (Pearson r ≥ 0.7). The relationship between platelet transfusion volume (mL/kg) and the percentage change in the MA was determined using linear regression, and a platelet transfusion calculator was generated. ConclusionsA lower MA during rewarming is associated with an increased risk of perioperative bleeding. In patients with a rewarming MA of less than 45 mm, an intraoperative platelet transfusion may reduce the risk of subsequent bleeding. Individualized platelet transfusion therapy based on rewarming TEG may reduce the risk of bleeding while minimizing unnecessary platelet transfusion.

In Search for the “Right Partner”

Left ventricular assist devices (LVAD) provide excellent results in the treatment of end-stage HF. However, right ventricular failure constrains LVAD therapy for advanced stages. To avoid postoperative RV failure, the combination with temporary right ventricular support (t-RVAD) have been suggested. Our clinical experience combining LVAD therapy with a groin-free approach, has shown promising results. The aim of this study was to analyze the outcome of LVAD with t-RVAD support in reference to BiVAD support. All patients in need of BiVAD therapy were retrospectively reviewed through our prospectively maintained database for cardiac surgery and our outpatient clinic RESULTS: 84 patients underwent biventricular assist therapy between 2007 and 2019 at our institution. BerlinHeart Excor was used in 58 patients, while 26 patients underwent LVAD therapy combined with t-RVAD support using the ProtekDuo cannula strategy. Mean age was 46.6 years (44.1 vs 52.3; p=0.01), while 73 patients (85) were males. Further demographic data were comparable between groups. Twenty-seven patients (32.1) were already on ECLS at the time of implantation. Surgical re-exploration for bleeding was necessary in 20 (23.8) patients (27.3 vs 17.6), while 7 (8.3) suffered adverse neurological events. Tracheotomy to facilitate weaning occurred in 27 (32.1) patients (32.8 vs 47.1), and postoperative SIRS was found in 37 (44) (50 vs. 47.1), with no significant difference between groups. Thirty patients (51.7) were successfully transplanted and t-RVAD was weaned in 25 (96) cases. Overall survival was 74.4 % (74.1 vs. 76.0) at 30 days and 54.4 % (55.0 vs.49.0) at one year (log rank 0.9) CONCLUSION: Our treatment strategy allows for comparable early and mid-term results in LVAD plus t-RVAD patients as compared to BIVAD support. This concept adds to the surgical armamentarium in the treatment of heart failure, especially in advanced stages. This approach has proven feasibility and may play a role in expanding the treatment options for patients needing LVAD support with an impaired RVF.

Association of postoperative blood pressure and bleeding after cardiac surgery

ObjectiveWe sought to characterize the relationship between postoperative blood pressure on the day of surgery and metrics of bleeding. MethodsIn a preplanned secondary analysis of prospectively collected data from the Limiting IV Chloride to Reduce AKI trial (NCT02020538), univariate and multivariable regression analyses explored the association between peak systolic blood pressure, peak mean arterial pressure, and peak central venous pressure recorded postoperatively on the day of surgery and multiple metrics of bleeding. Patients at increased bleeding risk due to specific criteria were excluded from analysis. The primary outcome was chest tube drainage (milliliters per hour) on the day of surgery. Secondary outcomes included red blood cell transfusion, surgical re-exploration for bleeding, and hospital mortality. ResultsThe study cohort comprised 793 patients. Mean ± standard deviation peak systolic blood pressure, mean arterial pressure, and central venous pressure were 125 ± 15 mm Hg, 83 ± 9 mm Hg, and 12 ± 4 mm Hg, respectively. Median (interquartile range) chest tube drainage on the day of surgery was 33 mL/hour (interquartile range, 23 mL/hour-51 mL/hour). Adjusted for prespecified variables, there was no positive association between peak systolic blood pressure and bleeding outcomes, including chest tube drainage (−2.2 mL/10 mm Hg; 95% confidence interval, −3.9 to −0.5 mL/h/10 mm Hg; P = .01) or volume of transfusion (−15 mL/10 mm Hg; 95% confidence interval, −29 to −1 mL/h/10 mm Hg; P = .04). Results remained broadly consistent across multiple secondary outcomes and regardless of whether systolic blood pressure or mean arterial pressure was the explanatory variable. ConclusionsThe lack of positive association between peak systolic blood pressure or peak mean arterial pressure with metrics of bleeding after cardiac surgery promotes equipoise for testing the influence of higher blood pressure targets during the early postoperative period.

Thromboelastography Is Associated With Surrogates for Bleeding After Pediatric Cardiac Operations

Perioperative bleeding is a common complication in pediatric patients undergoing cardiac operation. Although thromboelastography (TEG) has been used in patients undergoing adult cardiac operation, limited data are available in pediatric patients. We hypothesize that TEG variables may be associated with surrogate end points for postoperative bleeding in pediatric patients undergoing complex cardiac operation. In a retrospective study, TEG was obtained after protamine administration and on admission to the intensive care unit (ICU) in pediatric patients (≤18 years) undergoing cardiac operation that required cardiopulmonary bypass. A composite end point of extended bloodproduct transfusion or surgical re-exploration for bleeding was used as a surrogate for perioperative bleeding. TEG variables were compared between patients who did or did not reach the composite end point. The study included 511 pediatric patients undergoing complex cardiac operation. The composite end point was reached in 52% of patients with maximum amplitude (MA) less than 45 mm compared with 31% with MA of 45 mm or more (p < 0.001). With the use of multivariable regression analysis, MA less than 45 mm was independently associated with the composite end point (p< 0.001). Patients with MA less than 45 mm who received platelet transfusion in the operating room (OR) were less likely to reach the composite end point within the subsequent 24 hours (8%) compared with patients who did not receive intraoperative platelet transfusion (24%) (p= 0.02). Intraoperative TEG MA less than 45 mm is associated with a surrogate end point for intraoperative bleeding in pediatric patients undergoing complex cardiac operation. In patients with MA less than 45 mm, prophylactic platelet transfusion in the OR may be associated with reduction in bleeding end points in the ICU.

Validation of a definition of excessive postoperative bleeding in infants undergoing cardiac surgery with cardiopulmonary bypass

ObjectiveTo derive and validate an objective definition of postoperative bleeding in neonates and infants undergoing cardiac surgery with cardiopulmonary bypass. MethodsUsing a retrospective cohort of 124 infants and neonates, we included published bleeding definitions and cumulative chest tube output over different postoperative periods (eg, 2, 12, or 24 hours after intensive care unit admission) in a classification and regression tree model to determine chest tube output volumes that were associated with red blood cell transfusions and surgical re-exploration for bleeding in the first 24 hours after intensive care unit admission. After the definition of excessive bleeding was determined, it was validated via a prospective cohort of 77 infants and neonates. ResultsExcessive bleeding was defined as ≥7 mL/kg/h for ≥2 consecutive hours in the first 12 postoperative hours and/or ≥84 mL/kg total for the first 24 postoperative hours and/or surgical re-exploration for bleeding or cardiac tamponade physiology in the first 24 postoperative hours. Excessive bleeding was associated with longer length of hospital stay, increased 30-day readmission rate, and increased transfusions in the postoperative period. ConclusionsThe proposed standard definition of excessive bleeding is based on readily obtained objective data and relates to important early clinical outcomes. Application and validation by other institutions will help determine the extent to which our specialty should consider this definition for both clinical investigation and quality improvement initiatives.

(1070) - Blood Product Utilization in Continuous Flow Left Ventricular Assist Devices: Single Institution Trends

Despite successful blood product (BPs) conservation in adult cardiac surgery, use of BPs remains high during Continuous Flow-Left Ventricular Assist Device (CF-LVAD) implantation. We examined trends in BPs utilization during implantation of CF-LVADS. We reviewed the institutional Society of Thoracic Surgery (STS) database at an academic LVAD program from 2007 - 2015. Identified cohorts were: Destination (DT) or Bridge to Transplant (BTT), Heartware (HW) or Heartmate II (HM II), era of implantation (first 87 consecutive patients vs second 88 consecutive patients), and patients that received BPs intra or post-operatively (RBPs) or BPs naïve patients (BPN). Risk factors for BPs use were compared using the t-test or chi-square. Multivariate analysis was done with Cox PH regression. 5 year Kaplan-Meier survival curves were created and the log rank test was employed to compare groups. 176 patients underwent CF-LVAD implantation from 2007-2015. Cohorts were heterogeneous in preoperative variables. Multivariate analysis identified DT, HM II, early era, pre-operative hematocrit, and redo-sternotomies as significant independent risk factors for BPs use. 44 Patients (25% of CF-LVAD implantations) were managed without use of BPs. Surgical re-exploration for bleeding was 8 %. BPN patients had improved 30 day mortality (RBP 16.03% vs BPN 2.27%, p=0.047) and shorter ICU lengths of stay (RBP 249+/-215 hrs vs BPN 182+/-76 hrs, p=0.049). 5 year Kaplan-Meier curve trended towards improved survival for BPN patients but lacked significance (p=0.06). Index hospitalization hemoglobin nadir for RBP patients was 7.06+/-1.10 verse a nadir of 7.74+/-1.0 for BPN patients (p=<0.01). BPs use declined at our institution over the CF-LVAD implantation experience. DT, HM II, early era patients, pre-op hematocrit and redo-sternotomies were risk factors for BPs use. CF-LVADs can be safely implanted without any use of BPs. BPN patients had shorter ICU lengths of stay, improved 30 day mortality and trended towards improved 5 year survival. Post operatively patients can be safely managed with a hemoglobin less than 8 with good outcomes.

Re-Evaluation of the Role of Antifibrinolytic Therapy with Lysine Analogs in Liver Transplantation in The Post-Aprotinin Era

Purpose of review: Hemorrhage, blood and blood product transfusions and the need for surgical re-exploration for bleeding can have a detrimental effect on patient outcome during liver surgery. Following the suspension of aprotinin from the market only the antifibrinolytics tranexamic acid (TA) and epsilon-aminocaproic acid (EACA) are left as pharmacological options to reduce hemostatic activation and associated bleeding complications. Considering the apparent usefulnes of aprotinin in liver surgery and transplantation, its loss has left a void within the armamentarium of drugs available to reduce blood loss. The need for large independent safety studies has become evident. The current review focuses on the drugs that are available, the safety and efficacy data that supports their use and the indications warranting further trails. Recent findings: Both TA and EACA are effective in reducing blood loss and transfusion requirements in liver surgery. Analysis of data is complicated as the dosing regimens, especially for tranexamic acid, varies enormously and the agents are highly overdosed in most relevant trials. New data indicates that in a dose-dependent fashion, TA is associated with an increase in adverse events with transient renal failure highlighted as a particular problem. It appears that all the anti-fibrinolytics have side effects that may impact on morbidity and mortality and it may be that aprotinin is no worse. The use of these agents needs to be balanced against benefit especially in the management of high risk cases.

Mortality Benefit With Prasugrel in the TRITON–TIMI 38 Coronary Artery Bypass Grafting Cohort: Risk-Adjusted Retrospective Data Analysis

The objective of this study was to characterize the bleeding, transfusion, and other outcomes of patients related to the timing of prasugrel or clopidogrel withdrawal before coronary artery bypass grafting (CABG). There is little evidence to guide clinical decision making regarding the use of prasugrel in patients who may need urgent or emergency CABG. Experience with performing CABG in the presence of clopidogrel has raised concern about perioperative bleeding complications that are unresolved. A subset of the TRITON-TIMI 38 study (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis In Myocardial Infarction 38), in which patients with acute coronary syndrome were randomized to treatment with aspirin and either clopidogrel or prasugrel, underwent isolated CABG (N = 346). A supplemental case report form was designed and administered, and the data combined with the existing TRITON-TIMI 38 database. Baseline imbalances were corrected for using elements of the European System for Cardiac Operative Risk Evaluation and The Society of Thoracic Surgeons predictive algorithm. A significantly higher mean 12-h chest tube blood loss (655 ± 580 ml vs. 503 ± 378 ml; p = 0.050) was observed with prasugrel compared with clopidogrel, without significant differences in red blood cell transfusion (2.1 U vs. 1.7 U; p = 0.442) or the total donor exposure (4.4 U vs. 3.0 U; p = 0.463). All-cause mortality was significantly reduced with prasugrel (2.31%) compared with 8.67% with clopidogrel (adjusted odds ratio: 0.26; p = 0.025). Despite an increase in observed bleeding, platelet transfusion, and surgical re-exploration for bleeding, prasugrel was associated with a lower rate of death after CABG compared with clopidogrel.

Australian Experience with VAD as a Bridge to Paediatric Cardiac Transplantation

The Royal Children's Hospital, Melbourne is the National Paediatric Heart Transplant Centre of Australia. A variety of ventricular assist devices (VADs) have been used effectively as a bridge to heart transplantation in adult patients, however, the experience in the paediatric population is limited. We present our initial experience using the Thoratec and Medos VAD systems as a bridge to heart transplantation in the designated centre for paediatric cardiac transplantation in Australia. The medical records of all patients supported with a Thoratec or Medos VAD at the RCH from July 2005 to July 2007 were retrospectively reviewed. Seven patients between 5 and 16 years of age were supported with the Thoratec or Medos VAD during the period of study. All of the patients were supported with a left sided ventricular assist device (LVAD). The length of time supported ranged from 6 to 230 days, with a median of 22 days. Co-morbidities included surgical re-exploration for bleeding, cannula site wound infections and thromboembolic events. Two patients died before a donor heart became available. From our limited experience, the use of a VAD as a bridge to heart transplantation is a feasible option for children with end stage cardiac failure.

Multivariate predictors of blood product use in cardiac surgery

Objective: To determine factors associated with an increased risk of post-cardiopulmonary bypass (CPB) blood product usage in adult cardiac surgical patients. Design: Prospective observational study. Setting: Academic hospital. Participants: Patients undergoing cardiac surgery with CPB were studied over a 7-month period. Interventions: The outcomes studied were receipt of more than 2 U of packed red blood cells (PRBCs), receipt of any other blood component products (cryoprecipitate, fresh-frozen plasma [FFP], or platelets), or surgical re-exploration for bleeding. Preoperative and intraoperative risk factors for bleeding were analyzed. Measurements and Main Results: Increased age and preoperative creatinine level, low body surface area, preoperative hematocrit, nonelective surgery, lower temperature on bypass, and duration of bypass were associated with an increased risk of transfusion of >2 U of PRBCs. Low body surface area, repeat surgery, nonelective surgery, and CPB time were associated with transfusion of platelets, fresh-frozen plasma, or cryoprecipitate and/or surgical re-exploration. The following factors were associated with neither transfusion of more than 2 U of PRBC nor transfusion of platelets, FFP or cryoprecipitate, or surgical re-exploration: gender, preoperative international normalized ratio, preoperative antiplatelet medications, and preoperative intravenous heparin. Conclusion: Therapies aimed at reducing transfusion of blood products should be aimed at those patients with low body surface areas, baseline anemia, and those undergoing long or repeat surgeries. © 2003 Elsevier Inc. All rights reserved.

Abciximab and bleeding during coronary surgery: results from the EPILOG and EPISTENT trials

Background. Abciximab during percutaneous coronary revascularization reduces ischemic complications, but concern exists regarding increased bleeding risk should emergency coronary surgical procedures be required. Methods. Outcomes were assessed among 85 patients who required coronary artery bypass grafting operations after coronary intervention in two randomized placebo-controlled trials of abciximab. Comparisons were made between patients in the pooled placebo and abciximab groups. Results. The incidence of coronary surgical procedures was 2.17% and 1.28% among patients randomized to placebo and abciximab, respectively ( p = 0.021). Platelet transfusions were administered to 32% and 52% of patients in the placebo and abciximab groups, respectively ( p = 0.059). Rates of major blood loss were 79% and 88% in the placebo and abciximab groups, respectively ( p = 0.27); transfusions of packed red blood cells or whole blood were administered in 74% and 80% of patients, respectively ( p = 0.53). Surgical reexploration for bleeding was required in 3% and 12% of patients, respectively. Death and myocardial infarction tended to occur less frequently among patients who had received abciximab. Conclusions. Urgent coronary artery bypass grafting operations can be performed without an incremental increase in major hemorrhagic risk among patients on abciximab therapy.