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.
Keywords
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Article info
Publication history
Published online: July 27, 2021
Accepted:
June 8,
2021
Received in revised form:
May 31,
2021
Received:
March 8,
2021
Identification
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.
