Hemostasis in Off-Pump Compared to On-Pump Coronary Artery Bypass Grafting: A Prospective, Randomized Study

Vedin, Jenny; Antovič, Aleksandra; Ericsson, Anders; Vaage, Jarle

doi:10.1016/j.athoracsur.2005.02.036

Cited by 33 publications

(30 citation statements)

References 93 publications

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“…All 22 studies reported on the incidence of AKI, with seven studies defining AKI exclusively as the need for dialysis (25,26,33,47,49 -51). Six studies did not describe the criteria used to define AKI (27,34,35,42,46,48). The remaining nine studies defined AKI using variable absolute or relative increases in serum creatinine, decreases in GFR, decreases in urine output, or need for dialysis (Table 2) (28 -30,32,43-45, 52,53).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The remaining nine studies defined AKI using variable absolute or relative increases in serum creatinine, decreases in GFR, decreases in urine output, or need for dialysis (Table 2) (28 -30,32,43-45, 52,53). Death was ascertained in-hospital in nine trials (25,(27)(28)(29)32,34,46,48,51), at 30 days in nine trials (25,26,30,33,35,44,45,47,53), and at 60 days in one trial (42). The duration of follow-up was not documented in the three remaining studies (43,50,52).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Disagreements were resolved through consensus. Eleven authors were contacted by e-mail (up to three attempts per author) for additional information, including confirmation that there were no duplicate data and clarification of the AKI definition used in trials (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Five authors provided additional information (25,29,30,32,33).…”

Section: Data Abstractionmentioning

confidence: 99%

“…A total of 6256 potentially relevant citations were identified and screened, of which 5232 originated from MEDLINE; 224 articles were retrieved for detailed evaluation, of which 22 fulfilled eligibility criteria ( Figure 1) (25)(26)(27)(28)(29)(30)(32)(33)(34)(35)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53).…”

Section: Study Characteristicsmentioning

confidence: 99%

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Off-Pump Coronary Artery Bypass Surgery and Acute Kidney Injury

Seabra

Alobaidi

Balk

et al. 2010

Clinical Journal of the American Society of Nephrology

121

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Background and objectives: Off-pump coronary artery bypass grafting (CABG) has been advocated to cause less inflammation, morbidity, and mortality than the more traditional on-pump technique. This meta-analysis compares these two surgical techniques with respect to causing acute kidney injury (AKI).Design, setting, participants, & measurements: This study searched for randomized controlled trials in MEDLINE and abstracts from the proceedings of scientific meetings through February 2010. Included were trials comparing off-pump to on-pump CABG that reported the incidence of AKI, as defined by a mixture of criteria including biochemical parameter/urine output/dialysis requirement. Mortality was evaluated among the studies that reported kidney-related outcomes. For primary and subgroup analyses, fixed-effect meta-analyses of odds ratios (OR) were performed.Results: In 22 identified trials (4819 patients), the weighted incidence of AKI in the on-pump CABG group was 4.0% (95% confidence interval [CI] 1.8%, 8.5%), dialysis requirement 2.4% (95% CI 1.6%, 3.7%), and mortality 2.6% (95% CI 1.6%, 4.0%). By meta-analysis, off-pump CABG was associated with a 40% lower odds of postoperative AKI (OR 0.60; 95% CI 0.43, 0.84; P ‫؍‬ 0.003) and a nonsignificant 33% lower odds for dialysis requirement (OR 0.67; 95% CI 0.40, 1.12; P ‫؍‬ 0.12). Within the selected trials, off-pump CABG was not associated with a significant decrease in mortality.Conclusions: Off-pump CABG may be associated with a lower incidence of postoperative AKI but may not affect dialysis requirement, a serious complication of cardiac surgery. However, the different definitions of AKI used in individual trials and methodological concerns preclude definitive conclusions.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Data Abstractionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

Off-Pump Coronary Artery Bypass Surgery and Acute Kidney Injury

Seabra

Alobaidi

Balk

et al. 2010

Clinical Journal of the American Society of Nephrology

121

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“…This finding may be explained by better preservation of the haemostatic system in off-pump surgery; 11) however, we consider these differences in INR fairly subtle. The apparent thromboelastographic detection of fibrinolysis/hyperfibrinolysis in conventional CABG (group A), but not in OPCAB (group B) and modified cardiopulmonary bypass (group C) has already been published.…”

Section: Discussionmentioning

confidence: 80%

Postoperative Blood Loss in Coronary Surgery No Real Impact of Fibrinolysis Detected by Thromboelastography and D-Dimers. A Prospective, Randomized Study

Snircova

Jares

Malý³

et al. 2008

Int. Heart J.

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SUMMARYAlthough in many cardiac surgery centers pharmacological strategies based on fibrinolytic inhibitors are used on a routine basis, detailed knowledge of fibrinolysis during various settings of coronary surgery is still limited.Sixty-five patients scheduled for coronary surgery were randomized into 3 groups:group A -conventional coronary artery bypass grafting, group B -off-pump surgery, and group C -coronary artery bypass grafting with modified, rheoparin coated cardiopulmonary bypass with the avoidance of reinfusion of cardiotomy blood into the circuit. The sampling time points for rotation thromboelastographic evaluations were as follows: preoperatively, 15 minutes after sternotomy, on the completion of peripheral bypass anastomoses, at the end of the procedures, and 24 hours after the end of surgery. D-dimer levels were evaluated before surgery, at the end of procedures, and 24 hours after surgery. Thromboelastographic signs of fibrinolysis (evaluated by Lysis Onset Time-intergroup differences at 60 and 150 minutes of assessment: P = 0.003 and P < 0.001, respectively) were clearly detectable during cardiopulmonary bypass in group A, but not at any time in groups B and C. At the other sampling times all thromboelastographic parameters were similar in all groups. In group A, no exceptional bleeding tendency (during 24 hours), as compared to groups B and C (geometric means and 95% confidence intervals: group A: 686.7 [570.8; 826.1] mL, group B: 555.3 [441.3; 698.9] mL, group C: 775.6 [645.1; 932.3] mL, P = 0.157), and no significant correlations between Lysis Onset Time, postoperative blood loss, and D-dimer levels were found. No significant differences in postoperative blood loss related to cardiac surgeons and assistant surgeons were detected.Thromboelastographic signs of increased fibrinolysis were detectable in the important proportion of coronary surgery patients operated on with the use of conventional cardiopulmonary bypass, but not in off-pump patients and those operated on with the biocompatible surface-modified circuit without reinfusion of cardiotomy suction blood. These signs resolved spontaneously at the end of surgery and were not associated with increased postoperative bleeding. No significant correlation with D-dimer levels was found. (Int From the

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Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease

Møller

Penninga

Wetterslev

et al. 2012

Cochrane Database of Systematic Reviews

143

118

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Our systematic review did not demonstrate any significant benefit of off-pump compared with on-pump CABG regarding mortality, stroke, or myocardial infarction. In contrast, we observed better long-term survival in the group of patients undergoing on-pump CABG with the use of cardiopulmonary bypass and cardioplegic arrest. Based on the current evidence, on-pump CABG should continue to be the standard surgical treatment. However, off-pump CABG may be acceptable when there are contraindications for cannulation of the aorta and cardiopulmonary bypass. Further randomised clinical trials should address the optimal treatment in such patients.

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Hemostasis in Off-Pump Compared to On-Pump Coronary Artery Bypass Grafting: A Prospective, Randomized Study

Cited by 33 publications

References 93 publications

Off-Pump Coronary Artery Bypass Surgery and Acute Kidney Injury

Off-Pump Coronary Artery Bypass Surgery and Acute Kidney Injury

Postoperative Blood Loss in Coronary Surgery No Real Impact of Fibrinolysis Detected by Thromboelastography and D-Dimers. A Prospective, Randomized Study

Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease

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