ABSTRACT 59

BLOOD TRANSFUSION MANAGEMENT IN OFF-PUMP CORONARY ARTERY BYPASS SURGERY

Yousuf Mahomed, Palaniswamy Vijay, John W. Brown.  Indiana University School of Medicine, Indianapolis, IN

Technologies have made it possible to perform coronary artery bypass surgery on a beating heart (OPCAB).  An attractive feature of OPCAB is the reduction in blood component requirements.  We have studied the blood transfusion management in OPCAB.

OPCAB (Octopus 2, Medtronics, Minneapolis, MN) patients (n=100) were included in the study.  Based on their pre- and postoperative hemoglobin (Hb) levels, the patients were divided into group I (preopHb= postopHb) and II (preopHb>postopHb). Intraoperative blood volume management was recorded from patient charts.

In group I patients (n=29) the preop and postop Hb levels were 11±1.6 and 11.1±1.8mg/dL and in group II (n=71) the levels were 13.6±1.9 and 10.7±1.7mg/dL respectively (p=0.001).  The estimated blood loss during the surgery was 0.47±0.33L and 0.56±0.58L in group I and II respectively (p=NS).  Replacement fluids such as plasmalyte, heparin and albumin were not significantly different in both groups.  None of the patients in group I required cell saver blood, but 6 group II patients had cell saver blood given (0.43±0.13L).  The volume of RBC transfused was not different (0.6±1 vs 0.5±1units, p=NS), but the units of RBC transfused were 2.2±1.3units in conventional on-pump bypass surgery.  Both groups of patients had similar number of grafts (3±1) and operative times (212±48min).

Results show that postopHb levels decreased compared to their preoperative levels.  This decline in Hb is less than that encountered in conventional CABG, and does not warrant any additional need for fluids or blood components.