ESTIMATION OF INTRA-OPERATIVE BLOOD LOSS DURING OFF PUMP CABG

Abstract

Introduction
Patients with ischemic heart disease are on antiplatelet drugs or injectable heparin when referred for
a coronary artery bypass grafting (CABG) surgery. Hence, they have an increased tendency for
bleeding during the procedure. We conducted a study to estimate the actual amount of blood loss
both during sternotomy and entire off-pump CABG procedure (OPCAB).
Methods
The present study was conducted in the accrual period between July 2017 till June 2019 at Sri
Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, enrolling 50 consecutive
patients who fulfilled the inclusion criteria. Blood loss was estimated using gravimetric method by
weighing the blood soaked mops and gauzes used during the entire procedure.
Results
The average blood loss during sternotomy and at the end of the CABG was estimated in 50 patients
and it was found to be 294 ml and 797 ml respectively. Patients with left main coronary artery
disease (LMCA) who were on intravenous heparin pre-operatively bled 6.3% more than nonLMCA patients who were only on aspirin prior to surgery. Patients who received 1 and 2 grafts
bled 53% (p<0.0128) and 5% (p<0.036) lesser respectively than the average of the study population
and statistically significant difference was found (p≤ 0.001). Patients who received 3 and 4 grafts
bled about 4% and 16% respectively more than the average (p≥0.01).
Conclusion
Inevitable use of antiplatelet drugs and heparin in the pre-operative period increases blood loss
during surgery. Subset of females, patients with LMCA disease and those who required 3 or 4
bypass grafts had a significantly increased amount of blood loss at the end of surgery in the study
population