A1 Refereed original research article in a scientific journal
Coronary Artery Bypass Grafting in Patients With High Risk of Bleeding
Authors: Demal Till J, Fehr Samira, Mariscalco Giovanni, Reiter Beate, Bibiza Eric, Reichenspurner Hermann, Gatti Giuseppe, Onorati Francesco, Faggian Giuseppe, Salsano Antonio, Santini Francesco, Perrotti Andrea, Santarpino Giuseppe, Zanobini Marco, Saccocci Matteo, Musumeci Francesco, Rubino Antonino S, De Feo Marisa, Bancone Ciro, Nicolini Francesco, Dalén Magnus, Maselli Daniele, Bounader Karl, Mäkikallio Timo, Juvonen Tatu, Ruggieri Vito G, Biancari Fausto
Publisher: Elsevier
Publication year: 2022
Journal: Heart, Lung and Circulation
Journal name in source: Heart, lung & circulation
Journal acronym: Heart Lung Circ
Volume: 31
Issue: 2
First page : 263
Last page: 271
ISSN: 1443-9506
eISSN: 1444-2892
DOI: https://doi.org/10.1016/j.hlc.2021.06.519
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.
