Off-Pump Versus On-Pump Coronary Artery Surgery Identification of Fibrinolysis Using Rotation Thromboelastography; A Preliminary, Prospective, Randomized Study

Abstract

SUMMARYThe aim of this preliminary, prospective, randomized study was to compare rotation thromboelastography (roTEG) results and D-dimer levels in off-pump versus on-pump coronary surgery in order to identify the activation of fibrinolysis.Twenty patients scheduled for coronary bypass grafting were assessed (off-pump group A, n = 10; on-pump group B, n = 10). Blood samples for roTEG examination were taken preoperatively (t 0 ), 15 minutes after sternotomy (t 1 ), on the completion of peripheral bypass anastomoses (t 2 ), and at the end of procedures (t 3 ). The time points for D-dimer levels analyses were before operation, at the end of procedures, and 24 hours later.A certain degree of roTEG signs of fibrinolysis was noticed at time t 2 in both groups and in group B these marks were quite widely, but not significantly expressed (P for intergroup differences for Lysis on Set Time at 60 and 150 minutes were P = 0.190 and P = 0.122, respectively), borderline differences were found for Maximum Clot Firmness (P = 0.082) with a lower mean value for group B (arithmetic means [95% confidence intervals] -57.7 [54.2; 61.2] mm). Completely expressed roTEG signs of hyperfibrinolysis were observed in 2 patients from group B. In group B also the highest geometric means of Ddimers (1326.0 [943.5; 1863.6] ng mL -1 ) and thus a dramatic intergroup difference (P < 0.001) were observed at the end of surgery; 24 hours later the significantly elevated Ddimer levels in both groups (A: 1070.0 [723.5; 1582.6] versus B: 1093.3 [732.0; 1632.9] ng mL -1 ) were equalized (P = 0.932). Our roTEG results display a slightly greater, but fairly subtle activation of fibrinolysis during the course of cardiopulmonary bypass, compared to off-pump cardiac surgery. (Int Heart J 2007; 48: 57-67)

Topical application of antifibrinolytic drugs for on-pump cardiac surgery: a systematic review and meta-analysis

“…However, during cardiac surgery, high amounts of pericardial plasminogen activators are released following skin incision, sternotomy, and surgical tissue manipulation, which can subsequently lead to increased local fibrinolytic activity and excessive bleeding. 34 Consistent with this physiological evidence, the results of our systematic review showed that the topical application of antifibrinolytics into the pericardial tissues reduced postoperative chest-tube blood loss by 200 or 250 ml, on average, in aprotinin or tranexamic acid trials, respectively. Topical application of antifibrinolytics in other types of surgeries, such as neurosurgery, where the meninges and cerebral tissues contain high levels of tissue plasminogen activators, has also been shown to reduce surgical bleeding.…”

Clinico-demographic Characteristics of Coronary Artery Bypass Surgery Patients: Experience of 60 Cases at Referral Cardiac Surgery Hospital in Bangladesh

“…Age of the most of the patients was between 41 to 60 years. Jares et al (2007) reported the mean age of patients undergoing OPCAB surgery to be 53.80±8.57 years which are similar to this study.…”

Off-pump coronary artery bypass grafting improves short-term outcomes in high-risk patients compared with on-pump coronary artery bypass grafting: Meta-analysis

“…Performing the proximal 284 anastomoses while still on cross-clamp is a possible strategy aiming the reduction of further 285 manipulation of the aorta during conventional CABG, however the application of a side biting 286 clamp is usually described and accounts for a further risk of dislodging fragile material from 287 the aortic wall. OPCAB presents the same technical issue in proximal anastomoses, however, 288 especially in presence of a diffusely diseased aorta, off-pump procedures via complete in situ 289 grafting-'no-touch' -(double internal mammary artery and/or T-or Y-grafting) allow the 290 avoidance of any type of clamping and may reduce the risk of postoperative neurologic events 291 and cognitive functions impairment [36,37]. In studies included in the current analysis, the 292 proportion of no-touch technique was seldom reported.…”