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Malhotra A, Islam MA, Tavilla G, Williams NE, d'Amato T. Autologous cell salvage in off-pump coronary artery bypass surgery reduces post-operative complications: a retrospective weighted-matching analysis. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02012-2. [PMID: 38502459 DOI: 10.1007/s11748-024-02012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/24/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES Blood transfusion plays a crucial role in coronary artery bypass grafting (CABG). The choice between autologous cell saver (CS) and allogenic blood transfusion (ABT) has been a continuous debate in the medical community, especially within cardiac surgery. This study aimed to assess the outcomes of off-pump CABG (OPCAB) surgery in patients receiving blood solely via cell salvage compared to those receiving ABT or a combination of ABT and CS perioperatively. METHODS A total of 414 patients who underwent isolated OPCAB surgery at our cardiovascular clinic were analyzed. Among them, 250 patients (60.4%) received blood via CS alone, while 164 patients (39.6%) received either ABT or a mix of ABT and CS. Stabilized inverse probability treatment weighted (IPTW) matching technique ensured balance in baseline covariates. RESULTS We found no significant differences in 30-day mortality rates between the CS and ABT groups. The CS group displayed significantly lower rates of overall complications, encompassing stroke, acute kidney injury, atrial fibrillation, and pulmonary complications. Rates of sepsis, readmission, gastrointestinal complications, heparin-induced thrombosis, and deep venous thrombosis were comparable between the two groups. However, in contrast to the ABT group, the CS group exhibited significantly shorter median lengths of hospital stay (LOHS), ICU stay, and ventilation time, along with higher rates of discharge to home rather than acute care facilities. CONCLUSION Our data suggest that autologous blood transfusion via CS results in fewer perioperative complications and faster recovery following OPCAB procedures as compared to ABT.
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Affiliation(s)
- Amber Malhotra
- Department of Cardiovascular Surgery, Baylor Scott & White Medical Center-Temple, Temple, TX, USA
| | - Md Anamul Islam
- Department of Cardiovascular Surgery, Baylor Scott & White Medical Center-Temple, Temple, TX, USA.
| | - Giuseppe Tavilla
- Department of Cardiovascular Surgery, Baylor Scott & White Medical Center-Temple, Temple, TX, USA
| | - Nikki E Williams
- Department of Cardiovascular Surgery, Baylor Scott & White Medical Center-Temple, Temple, TX, USA
| | - Thomas d'Amato
- Department of Cardiovascular Surgery, Baylor Scott & White Medical Center-Temple, Temple, TX, USA
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Malhotra A, Garg P, Bishnoi AK, Sharma P, Wadhawa V, Shah K, Patel S, Ahirwar UK, Rodricks D, Pandya H. Dialyzer-based cell salvage system: a superior alternative to conventional cell salvage in off-pump coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2017; 24:489-497. [PMID: 28062681 DOI: 10.1093/icvts/ivw371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/19/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives Our goal was to test the hypothesis that the use of a dialyzer-based cell salvage system during off-pump coronary artery bypass grafting (OPCABG) reduces requirements for homologous blood transfusions (HBT) and improves postoperative haemtochemical parameters. Methods Data were prospectively collected for 222 patients who had OPCABG using 3 different cell salvage techniques: (1) dialyzer-based cell salvage (DBCS) ( n = 75), (2) conventional cell salvage (CCS) ( n = 73) and (3) without cell salvage (WCS) ( n = 74). Salvaged blood was transfused at the end of the operation. The primary outcome of the study was the amount of homologous blood transfused. Secondary outcomes were changes in haemtochemical parameters, postoperative bleeding, need for non-invasive ventilation (NIV), postoperative complications, renal dysfunction, clotting derangement, duration of intensive care unit (ICU) and hospital stay and mortality rates. Results There were no deaths. In patients with >1000 ml blood loss, there was a significant reduction in HBT in the DBCS group (300 ± 161 ml) compared with the WCS group (550 ± 85 ml) ( P < 0.0001). Postoperative changes in haemtochemical parameters were significantly fewer in the DBCS group compared with the other 2 groups. The incidence of NIV ( P = 0.002), renal dysfunction ( P = 0.009) and postoperative complications ( P = 0.003) was least in the DBCS group and highest in the WCS group. Mean ICU stays were comparable ( P = 0.208); however, the mean hospital stay was significantly shorter in the DBCS group (6.08 ± 3.12 days) compared with the WCS group (7.54 ± 4.46 days) ( P = 0.022). There was no significant increase in coagulopathy in any group as suggested by comparable chest tube drainage ( P = 0.285) and comparable prothrombin time. Conclusions The use of the DBCS system in OPCABG resulted in a significant reduction in HBT, improvement in postoperative levels of haemoglobin, platelets and albumin and reduction in complications without increased risk of coagulopathy.
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Affiliation(s)
- Amber Malhotra
- Department of Cardiovascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center (Affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
| | - Pankaj Garg
- Department of Cardiovascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center (Affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
| | - Arvind Kumar Bishnoi
- Department of Cardiovascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center (Affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
| | - Pranav Sharma
- Department of Cardiovascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center (Affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
| | - Vivek Wadhawa
- Department of Cardiovascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center (Affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
| | - Komal Shah
- Department of Research, U.N. Mehta Institute of Cardiology and Research Center (Affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
| | - Sanjay Patel
- Department of Research, U.N. Mehta Institute of Cardiology and Research Center (Affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
| | - Umesh Kumar Ahirwar
- Department of Perfusion, U.N. Mehta Institute of Cardiology and Research Center (Affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
| | - Dayesh Rodricks
- Department of Perfusion, U.N. Mehta Institute of Cardiology and Research Center (Affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
| | - Himani Pandya
- Department of Research, U.N. Mehta Institute of Cardiology and Research Center (Affiliated to BJ Medical College, Ahmedabad), Ahmedabad, Gujarat, India
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