Journal Article

110A BIOCOMPATIBLE PERFUSION STRATEGY IS SAFE AND IS ASSOCIATED WITH EXCELLENT CLINICAL OUTCOMES AND REDUCED BLOOD TRANSFUSIONS IN A CONTEMPORARY SERIES OF PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING: A TWO-CENTRE STUDY

O. Shapira, A. Korach, F. Pinaud, A. Dabah, Y. Bao, J.J. Corbeau, J.L. de Brux and C. Baufreton

in Interactive CardioVascular and Thoracic Surgery

Published on behalf of European Association for Cardio-Thoracic Surgery

Volume 17, issue suppl_2, pages S96-S96
Published in print October 2013 | ISSN: 1569-9293
Published online October 2013 | e-ISSN: 1569-9285 | DOI: http://dx.doi.org/10.1093/icvts/ivt372.110
110A BIOCOMPATIBLE PERFUSION STRATEGY IS SAFE AND IS ASSOCIATED WITH EXCELLENT CLINICAL OUTCOMES AND REDUCED BLOOD TRANSFUSIONS IN A CONTEMPORARY SERIES OF PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING: A TWO-CENTRE STUDY

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Objectives: The 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.

Methods: The BPS consisted of a membrane oxygenator, tip-to-tip closed-system heparin-bonded cardiopulmonary bypass circuits without a cardiotomy reservoir, low systemic anticoagulation (target activated clotting time 300 s) 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 database definitions.

Results: Nine-hundred and sixty-four consecutive patients (mean age 66 ± 11 years, 83% male) undergoing CABG between 2008 and 2012 were enrolled. Thirty-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. Median 24 h chest tube drainage was 380 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 left ventricular ejection fraction and haematocrit. Priority of surgery, dual antiplatelet therapy and cardiopulmonary bypass time were not predictors of adverse outcomes or blood transfusions.

Conclusions: In a contemporary cohort of patients undergoing CABG, the use of the BPS is safe and effective. It is associated with excellent clinical outcomes and reduced allogeneic blood transfusions.

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Subjects: Cardiovascular Medicine ; Cardiothoracic Surgery

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