On-pump versus off-pump CABG: Study of platelet activation

ABSTRACT

Coronary revascularization on a beating heart avoids many of the side effects of cardiopulmonary bypass. Off-pump coronary bypass surgery offers an excellent chance to examine the impact of the surgery and the relatively high dose of heparin on platelet functions without using cardiopulmonary bypass. Sixty patients with coronary artery disease were prospectively randomized to [1] on-pump CABG with conventional cardiopulmonary bypass and worm cardioplegic arrest and [2] off-pump CABG on the beating heart. Platelet studies including bleeding time, platelet count, mean platelet volume, platelet aggregation using ADP and surface expression of P-selectin and Annexin-V using flow cytometry as markers of platelet activation. Platelet studies revealed definite platelet dysfunction in the on-pump group, however there was still statistically significant elevation of markers of platelet activation in the off-pump group. Platelet activation occurs in coronary bypass surgery even when CPB is no used. This may correlate with previous reports of thrombotic complications of OPCAB surgery