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J Thorac Cardiovasc Surg 2001;121:920-922
© 2001 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Thrombotic complications in beating heart operations

From the Departments of Cardiac Surgery^a and Hematology,^b Montreal Heart Institute, Montreal, Quebec, Canada.

Received for publication June 15, 2000. Revisions requested Aug 30, 2000; revisions received Oct 20, 2000. Accepted for publication Nov 21, 2000. Address for reprints: Raymond Cartier, MD, Department of Cardiac Surgery, Montreal Heart Institute, 5000 Belanger St East, Montreal, Quebec H1T 1C8, Canada (E-mail: RC2910{at}aol.com).

Background: Off-pump coronary artery operations have recently gained popularity among the community of cardiac surgeons. Because the use of cardiopulmonary bypass is avoided, full anticoagulation is generally not sought to decrease perioperative blood loss and transfusion needs. Traditionally, patients undergoing coronary artery bypass operations with cardiopulmonary bypass are not considered at risk of having venous or arterial thromboembolic complications, and prophylaxis is generally not recommended.
Methods and results: We have reviewed our experience with off-pump coronary bypass operations, focusing on thromboembolic complications with clinical manifestations, and compared these findings with our experience with cardiopulmonary bypass operations. In our series of 500 off-pump cases, thromboembolic complications occurred in 1%, causing death in 1 patient, whereas in a contemporary cohort of 1476 patients operated on with cardiopulmonary bypass, thromboembolic complications resulted in stroke in 0.5% of the cases. This difference did not reach statistical significance.
Conclusions: Thromboembolic complications in off-pump coronary bypass operations are comparable with those in cardiopulmonary bypass operations. Although the prevalence of this complication remains low, the associated morbidity should lead to reconsideration of prophylactic measures.

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