Clinical Application Of Perioperative Non-allogeneic Transfusion In Off-pump Coronary Artery Bypass Grafting

Objectives To analyze the clinical application of perioperative non-allogeneic transfusion in off-pump coronary artery bypass grafting(OPCABG),and to explore how to achieve non-allogeneic transfusion in OPCABG.Methods Retrospectively analyze patients who underwent first isolated off-pump coronary artery bypass grafting in the the Second Hospital of Jilin University from January 2012 to October 2018.According to whether or not transfused with allogeneic blood in the perioperative period,all the patients were divided into two groups,which were non-allogeneic transfusion group and allogeneic transfusion group.Comparatively analyze the clinical indicators of the two groups,including preoperative and intraoperative indicators such as Sino SCORE risks assessment,gender,age,body mass index(BMI),left ventricular ejection fraction(LVEF),blood routine,coagulation function,liver function,renal function,blood lipids,myocardial damage markers,past history of myocardial infarction,preoperative percutaneous coronary intervention,preoperative mild heart valvular diseases,preoperative left main coronary artery stenosis>50%,the number of bypass grafts,and postoperative indicators such as the volume of mediastinal and pericardiac drainage duiring the first24 hours,mechanical ventilation time,ICU monitoring time,hospitalization time,hospitalization expenses and the incidence of postoperative complications such as the placement of intra-aortic balloon pump(IABP),reopen surgery,ventricular fibrillation,atrial fibrillation,infection,perioperative myocardial infarction,low cardiac output syndrome,cerebrovascular accident,acute renal injury,and all-cause deaths in the hospital.Propensity score matching(PSM)was conducted to reduce confoundingbias between the groups in preoperative and intraoperative indicators.The postoperative indicators of the two groups were compared to analyze the clinical application effect of non-allogeneic transfusion and allogeneic transfusion in off-pump coronary artery bypass grafting.Results A total of 1379 patients were enrolled in the retrospective cohort study.Patients were divided into non-allogeneic transfusion group(n=1270)and al ogeneic transfusion group(n=109)according to whether or not transfused with allogeneic blood in the perioperative period.Preoperative and intraoperative clinical data: gender(male/female): non-allogeneic transfusion group 868/402 vs al ogeneic transfusion group 63/46,p<0.05;hematocrit(%):non-allogeneic transfusion group 40.63±5.04 vs al ogeneic transfusion group 39.52±5.30,p<0.05;prothrombin time(s):non-allogeneic transfusion group 11.39±0.74 vs al ogeneic transfusion group 11.56±0.85,p<0.05;past history of myocardial infarction[n(%)]:non-allogeneic transfusion group 144(11.34%)vs allogeneic transfusion group 20(18.35%),p<0.01;past history of PCI [n(%)]: non-allogeneic transfusion group 113(8.90%)vs allogeneic transfusion group 24(22.02%),p<0.01;preoperative left main stenosis>50%[n(%)]: non-allogeneic transfusion group 156(12.28%)vs al ogeneic transfusion group 24(22.02%),p<0.01.There were no significant differences in the remaining indicators between the two growps(p>0.05).The propensity score matching(PSM)was used to reduce the confounding bias between the two groups.A total of 103 pairs namely 206 cases were matched 1:1 by the nearest-neighbor principle of PSM,with the accuracy of 0.05.There were no statistical y difference between the two groups in preoperative and intraoperative clinical data after the propensity score matching.Postoperative clinical data: compared with the allogeneic transfusion group,the non-allogeneic transfusion group had shorter mechanical ventilation time(12.18±7.20 vs 19.36±10.04 h,p<0.05),shorter ICU monitoring time(27.25±10.47 vs 34.31± 12.84 h,p<0.05),shorter hospitalization time(11.66 ± 5.17 vs 16.07 ± 8.02 d,p<0.05),less hospitalization expenses(11.76 ± 3.88 vs 15.58 ± 8.81 ten thousand yuans,p<0.05),and less incidence of postoperative complications such as ventricularfibrillation(1(0.97%)vs 7(6.79%),p<0.05),atrial fibrillation(7(6.79%)vs 16(15.50%),p<0.05)and infection(3(2.91%)vs 10(9.71%),p<0.05).There was no significant difference in the volume of mediastinal and pericardiac drainage duiring the first 24 hours,and the incidence of postoperative complications such as the placement of intra-aortic balloon pump(IABP),reopen surgery,perioperative myocardial infarction,low cardiac output syndrome,cerebrovascular accident,acute renal injury,and all-cause deaths in the hospital between the two groups(all p>0.05).Conclusions The application of perioperative non-allogeneic transfusion in off-pump coronary artery bypass grafting is meaningful and effective,which can significantly reduce the mechanical ventilation time,ICU monitoring time,hospitalization time,hospitalization expenses and the incidence of postoperative complications such as ventricular fibril ation,atrial fibrillation,and infection,and thererby improve the prognosis of patients and bring significant economic and social benefits to patients.For how to reduce perioperative allogeneic transfusion in off-pump coronary artery bypass grafting,our study suggests:(1)improve the preoperative risk assessment of bleeding and blood transfusion,and timely discontinue anticoagulants and antiplatelets,and correct anemia;(2)apply autologous blood transfusion techniques during the surgery;(3)strengthen the surgical skill and hemostasis skill,and apply the hemostatic drugs simultaneously;(4)implement a multi-disciplinary and unified blood transfusion indication.