Surgical Treatment Of High Risk Left Main Coronary Artery Disease

Objective: To evaluate the effects of dual antiplatelet therapy with aspirin and clopidogrel on postoperative bleeding,blood transfusion and complications after coronary artery bypass grafting in patients with high risk left main coronary artery disease.Methods: The 115 cases of patients with high risk left main coronary disease undergoing off-pump coronary artery bypass grafting from 2015 year to 2016 year in cardiac vascular surgery of the second hospital of Hebei Medical University,according to discontinuation of dual antiplatelet therapy(aspirin and clopidogrel)time,patients were divided into preoperative discontinuation for 5 days and more than 5 days group(A group),preoperative discontinuation 3~4 days group(B group),preoperative discontinuation 1 day group(C group)and sustained medication group(D group).The postoperative thoracic drainage volume,blood transfusion volume,adverse cardiovascular events(acute myocardial infarction,death),and the two thoracotomy hemostasis were compared between the four groups.There were 3 cases of acute myocardial infarction,two cases of thoracotomy hemostasis,and 3 cases of death in hospital.Results:1 There was no statistically significant difference of the baseline data of four groups of patients including age,gender,height and weight,hypertension,hyperlipidemia,diabetes history,left ventricular ejection fraction,hemoglobin,platelet count(P>0.05).2 There was no significant difference between the four groups in the operation time,the incidence of acute myocardial infarction,the incidence of the two thoracotomy,and the hospital mortality(P>0.05).The postoperative24 h flow rate in group C and group D was significantly higher than that in group A[(596.82±412.682)vs.(611.18±210.745)vs.(403.76±116.073)mL,P<0.05].B group was higher than A group,but the difference was not statistically significant.The total postoperative drainage volume was significantly higher in C group and D group than in A group,the difference was statistically significant(P<0.05).3 There was no significant difference between the four groups in plasma transfusion(P > 0.05).Four groups of patients did not lose platelets.The demand for red blood cells with C group and D group were significantly higher than that of A group,the difference was statistically significant(P <0.05).There was significant difference of the requirement of cryoprecipitate between the A group and D group(P<0.05).Conclusion: The use of dual antiplatelet drugs within 5 days of off-pump coronary artery bypass grafting increases the volume of postoperative drainage and blood transfusion,but does not increase the risk of serious bleeding and early postoperative mortality.For patients with high risk coronary artery disease who underwent off-pump coronary artery bypass grafting,the actual situation of the patients should be considered.If necessary,can shorten the time of drug withdrawal.