Coronary Artery Bypass Grafting in Patients With High Risk of Bleeding - 10/01/22
, Samira Fehr, MD a, b, Giovanni Mariscalco, MD, PhD c, Beate Reiter, MD a, Eric Bibiza, MSc d, Hermann Reichenspurner, MD, PhD a, Giuseppe Gatti, MD e, Francesco Onorati, MD, PhD f, Giuseppe Faggian, MD f, Antonio Salsano, MD g, Francesco Santini, MD g, Andrea Perrotti, MD, PhD h, Giuseppe Santarpino, MD i, j, k, Marco Zanobini, MD l, Matteo Saccocci, MD l, Francesco Musumeci, MD m, Antonino S. Rubino, MD, PhD n, o, Marisa De Feo, MD, PhD o, Ciro Bancone, MD, PhD o, Francesco Nicolini, MD, PhD p, Magnus Dalén, MD, PhD q, Daniele Maselli, MD r, Karl Bounader, MD s, Timo Mäkikallio, MD, PhD t, Tatu Juvonen, MD, PhD u, v, Vito G. Ruggieri, MD w, Fausto Biancari, MD, PhD u, v, xAbstract |
Background |
Postoperative bleeding after cardiac surgery is associated with increased morbidity and mortality. We tested the hypothesis that patients with a preoperatively estimated high risk of severe perioperative bleeding may have impaired early outcome after on-pump versus off-pump coronary artery bypass grafting (CABG).
Method |
Data from 7,352 consecutive patients who underwent isolated CABG from January 2015 to May 2017 were included in the multicentre European Coronary Artery Bypass Grafting registry. The postoperative bleeding risk was estimated using the WILL-BLEED risk score. Of all included patients, 3,548 had an increased risk of severe perioperative bleeding (defined as a WILL-BLEED score ≥4) and were the subjects of this analysis. We compared the early outcomes between patients who underwent on-pump or off-pump CABG using a multivariate mixed model for risk-adjusted analysis.
Results |
Off-pump surgery was performed in 721 patients (20.3%). On-pump patients received more packed red blood cell units (on-pump: 1.41 [95% confidence interval {CI} 0.99–1.86]; off-pump: 0.86 [95% CI 0.64–1.08]; p<0.001), had a longer stay in the intensive care unit (on-pump: 4.4 [95% CI 3.6–8.1] days; off-pump: 3.2 [95% CI 2.0–4.4] days; p=0.049), and a higher rate of postoperative atrial fibrillation (on-pump: 46.5% [95% CI 34.9–58.1]; off-pump: 31.3% [95% CI 21.7–40.9]; p=0.025). Furthermore, on-pump patients showed a trend towards a higher rate of postoperative stroke (on-pump: 2.4% [95% CI 0.9–4.1]; off-pump: 1.1 [95% CI 0.2–2.7]; p=0.094).
Conclusion |
Our data suggest that in patients with an increased risk of bleeding, the use of cardiopulmonary bypass is associated with higher morbidity. These patients may benefit from off-pump surgery if complete revascularisation can be ensured.
Le texte complet de cet article est disponible en PDF.Keywords : CABG, Off-pump, Cardiopulmonary bypass, Bleeding complications
Plan
Vol 31 - N° 2
P. 263-271 - février 2022 Retour au numéro
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