Blood product use in cardiac revascularization: Comparison of on- and off-pump techniques

Background. Cardiac revascularization on a beating heart avoids the side ef fects of cardiopulmonary bypass leg, neurologic injury, hemodilution, and c oagulopathy). We examined perioperative bleeding and use of blood products during coronary artery bypass grafting using either on-pump or off-pump tec hniques. Method. The charts of 126 patients who had coronary artery bypass grafting were reviewed. Data from 66 patients revascularized off pump and 60 patient s with cardiopulmonary bypass ton pump) were analyzed using unpaired Studen t's t test. Results. Average age was 62.5 years in either group. More patients received heparin preoperatively in the off-pump group that resulted in mild elevati on of preoperative partial thromboplastin time and activated clotting time (40.4 +/- 2.9 seconds and 150.1 +/- 5.3 seconds, respectively). However, th e off-pump group had less perioperative (intraoperative or postoperative) b leeding (2312 +/- 212 mt versus 3251 +/- 155 mt, p < 0.05) and required few er blood products compared with the on-pump group. Hemoglobin and platelets decreased more in the conventional on-pump group. Conclusions. Avoiding cardiopulmonary bypass decreases perioperative bleedi ng and, consequently, reduces the use of blood products after coronary arte ry bypass grafting, which might result in fewer transfusion-related complic ations. (C) 1999 by The Society of Thoracic Surgeons.