Coronary Artery Bypass Grafting in Patients With High Risk of Bleeding
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Coronary Artery Bypass Grafting in Patients With High Risk of Bleeding. / Demal, Till J; Fehr, Samira; Mariscalco, Giovanni; Reiter, Beate; Bibiza, Eric; Reichenspurner, Hermann; Gatti, Giuseppe; Onorati, Francesco; Faggian, Giuseppe; Salsano, Antonio; Santini, Francesco; Perrotti, Andrea; Santarpino, Giuseppe; Zanobini, Marco; Saccocci, Matteo; Musumeci, Francesco; Rubino, Antonino S; De Feo, Marisa; Bancone, Ciro; Nicolini, Francesco; Dalén, Magnus; Maselli, Daniele; Bounader, Karl; Mäkikallio, Timo; Juvonen, Tatu; Ruggieri, Vito G; Biancari, Fausto.
In: HEART LUNG CIRC, Vol. 31, No. 2, 02.2022, p. 263-271.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Coronary Artery Bypass Grafting in Patients With High Risk of Bleeding
AU - Demal, Till J
AU - Fehr, Samira
AU - Mariscalco, Giovanni
AU - Reiter, Beate
AU - Bibiza, Eric
AU - Reichenspurner, Hermann
AU - Gatti, Giuseppe
AU - Onorati, Francesco
AU - Faggian, Giuseppe
AU - Salsano, Antonio
AU - Santini, Francesco
AU - Perrotti, Andrea
AU - Santarpino, Giuseppe
AU - Zanobini, Marco
AU - Saccocci, Matteo
AU - Musumeci, Francesco
AU - Rubino, Antonino S
AU - De Feo, Marisa
AU - Bancone, Ciro
AU - Nicolini, Francesco
AU - Dalén, Magnus
AU - Maselli, Daniele
AU - Bounader, Karl
AU - Mäkikallio, Timo
AU - Juvonen, Tatu
AU - Ruggieri, Vito G
AU - Biancari, Fausto
N1 - Copyright © 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
PY - 2022/2
Y1 - 2022/2
N2 - BACKGROUND: Postoperative bleeding after cardiac surgery is associated with increased morbidity and mortality. We tested the hypothesis that patients with a preoperatively estimated high risk of severe perioperative bleeding may have impaired early outcome after on-pump versus off-pump coronary artery bypass grafting (CABG).METHOD: Data from 7,352 consecutive patients who underwent isolated CABG from January 2015 to May 2017 were included in the multicentre European Coronary Artery Bypass Grafting registry. The postoperative bleeding risk was estimated using the WILL-BLEED risk score. Of all included patients, 3,548 had an increased risk of severe perioperative bleeding (defined as a WILL-BLEED score ≥4) and were the subjects of this analysis. We compared the early outcomes between patients who underwent on-pump or off-pump CABG using a multivariate mixed model for risk-adjusted analysis.RESULTS: Off-pump surgery was performed in 721 patients (20.3%). On-pump patients received more packed red blood cell units (on-pump: 1.41 [95% confidence interval {CI} 0.99-1.86]; off-pump: 0.86 [95% CI 0.64-1.08]; p<0.001), had a longer stay in the intensive care unit (on-pump: 4.4 [95% CI 3.6-8.1] days; off-pump: 3.2 [95% CI 2.0-4.4] days; p=0.049), and a higher rate of postoperative atrial fibrillation (on-pump: 46.5% [95% CI 34.9-58.1]; off-pump: 31.3% [95% CI 21.7-40.9]; p=0.025). Furthermore, on-pump patients showed a trend towards a higher rate of postoperative stroke (on-pump: 2.4% [95% CI 0.9-4.1]; off-pump: 1.1 [95% CI 0.2-2.7]; p=0.094).CONCLUSION: Our data suggest that in patients with an increased risk of bleeding, the use of cardiopulmonary bypass is associated with higher morbidity. These patients may benefit from off-pump surgery if complete revascularisation can be ensured.
AB - BACKGROUND: Postoperative bleeding after cardiac surgery is associated with increased morbidity and mortality. We tested the hypothesis that patients with a preoperatively estimated high risk of severe perioperative bleeding may have impaired early outcome after on-pump versus off-pump coronary artery bypass grafting (CABG).METHOD: Data from 7,352 consecutive patients who underwent isolated CABG from January 2015 to May 2017 were included in the multicentre European Coronary Artery Bypass Grafting registry. The postoperative bleeding risk was estimated using the WILL-BLEED risk score. Of all included patients, 3,548 had an increased risk of severe perioperative bleeding (defined as a WILL-BLEED score ≥4) and were the subjects of this analysis. We compared the early outcomes between patients who underwent on-pump or off-pump CABG using a multivariate mixed model for risk-adjusted analysis.RESULTS: Off-pump surgery was performed in 721 patients (20.3%). On-pump patients received more packed red blood cell units (on-pump: 1.41 [95% confidence interval {CI} 0.99-1.86]; off-pump: 0.86 [95% CI 0.64-1.08]; p<0.001), had a longer stay in the intensive care unit (on-pump: 4.4 [95% CI 3.6-8.1] days; off-pump: 3.2 [95% CI 2.0-4.4] days; p=0.049), and a higher rate of postoperative atrial fibrillation (on-pump: 46.5% [95% CI 34.9-58.1]; off-pump: 31.3% [95% CI 21.7-40.9]; p=0.025). Furthermore, on-pump patients showed a trend towards a higher rate of postoperative stroke (on-pump: 2.4% [95% CI 0.9-4.1]; off-pump: 1.1 [95% CI 0.2-2.7]; p=0.094).CONCLUSION: Our data suggest that in patients with an increased risk of bleeding, the use of cardiopulmonary bypass is associated with higher morbidity. These patients may benefit from off-pump surgery if complete revascularisation can be ensured.
KW - Atrial Fibrillation
KW - Cardiopulmonary Bypass
KW - Coronary Artery Bypass/adverse effects
KW - Coronary Artery Bypass, Off-Pump/adverse effects
KW - Humans
KW - Postoperative Complications/epidemiology
KW - Retrospective Studies
KW - Treatment Outcome
U2 - 10.1016/j.hlc.2021.06.519
DO - 10.1016/j.hlc.2021.06.519
M3 - SCORING: Journal article
C2 - 34330630
VL - 31
SP - 263
EP - 271
JO - HEART LUNG CIRC
JF - HEART LUNG CIRC
SN - 1443-9506
IS - 2
ER -
