Effect of special anticoagulation method of hybrid coronary revascularization procedure on postoperative bleeding and clinical outcomes / 中华麻醉学杂志

ABSTRACT

Objective To investigate the effects of special anticoagulation method of hybrid coronary revascularization procedure on postoperative bleeding and clinical outcomes.Methods One hundred and forty-one ASA Ⅱ or Ⅲ consecutive patients,aged 35-82 yr,weighing 45-105 kg,undergoing one-stop hybrid coronary revascularization procedure from June 2007 to January 2011 in Fuwai cardiovascular hospital were enrolled and served as Hybrid group.Using propensity score methodology,these patients were matched with another 141 patients who had undergone off-pump coronary artery bypass grafting (OPCAB group) during the same period,selecting from the surgical database.These ASAⅡ or Ⅲ 141 patients,aged 43-80 yr,weighing 47-110 kg,who underwent OPCAB,were served as control subjects.In group Hybrid,the left internal mammary artery was isolated and then 100-120 U/kg heparin was administrated to maintain activated clotting time between 250-300 s,and additional heparin was given if needed.Protamine 1 mg/kg was used to reverse the effect of heparin after anastomosis between left internal mammary artery and left anterior descending branch.Before stent implantation,6000-8000 U heparin and 300 mg clopidogrel were administrated.Activated clotting time was maintained between 200-250 s until the end of operation.Clopidogrel 75 mg/d was taken for at least 12 months after operation.The volume of postoperative chest tube drainage,mechanical ventilation time,length of stay in intensive care unit,postoperative transfusion of allogeneic blood,re-intubation,myocardial damage,acute kidney injury,atelectasis,hydrothorax and thromboembolism were recorded.Results No thromboembolism was observed within the stent during stay in hospital after operation in patients.The volume of chest tube drainage was significantly less,mechanical ventilation time and length of stay in intensive care unit were shorter,the incidence of atelectasis and hydrothorax and transfusion of allogeneic blood requirement were lower in Hybrid group than in OPCAB group (P ＜ 0.05).There was no significant difference in the incidences of re-intubation,myocardio damage,and acute kidney injury between the two groups (P ＞0.05).Conclusion Special anticoagulation method of hybrid coronary revascularization procedure does not increase postoperative bleeding and has a better clinical outcomes during the early period.