Reduced postoperative blood loss and transfusion requirement after beating-heart coronary operations: A prospective randomized study

Objective: Coronary artery bypass grafting on the beating heart through med ian sternotomy is a relatively new treatment, which allows multiple revascu larization without the use of cardiopulmonary bypass. A prospective randomi zed study was designed to investigate the effect of coronary bypass with or without cardiopulmonary bypass on postoperative blood loss and transfusion requirement. Methods: Two hundred patients with coronary artery disease were prospec tiv ely randomized to (1) on-pump treatment with conventional cardiopulmonary b ypass and cardioplegic arrest and (2) off-pump treatment on the beating hea rt. Postoperative blood loss identified as total chest tube drainage, trans fusion requirement, and related costs together with hematologic indices and clotting profiles were analyzed. Results: There was no difference between the groups with respect to preoper ative and intraoperative patient variables. The mean ratio of postoperative blood loss and 95% confidence interval between groups was 1.64 and 1.39 to 1.94, respectively, suggesting on average a postoperative blood loss 1.6 t imes higher in the on-pump group compared with the off-pump group. Seventy- seven patients in the off-pump group required no blood transfusion compared with only 48 in the on-pump group (P < .01). Furthermore, less than 5% of patients in the on-pump group required fresh frozen plasma and platelet tra nsfusion compared with 30% and 25%, respectively, in the on-pump group (bot h P < .05). Mean transfusion cost per patient was higher in the on-pump com pared with that in the off-pump group ($184.8 +/- $35.2 vs $21.47 +/- $6.9, P < .01). Conclusions: Coronary artery bypass grafting on the beating heart is associ ated with a significant reduction in postoperative blood loss, transfusion requirement, and transfusion-related cost when compared with conventional r evascularization with cardiopulmonary bypass and cardioplegic arrest.