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J Thorac Cardiovasc Surg 2003;126:7-10
© 2003 The American Association for Thoracic Surgery

Editorial

Is there a hypercoagulable state after off-pump coronary artery bypass surgery? What do we know and what can we do?

Paul A. Kurlansky, MDa,*

a Miami Heart Research Institute, Miami Beach, Fla, USA.

Received for publication September 18, 2002; accepted for publication September 23, 2002.

* Address for reprints: Paul A. Kurlansky, MD, Miami Heart Research Institute, 801 Arthur Godfrey Rd, 5th Floor, Miami Beach, FL 33140, USA
doctorwu18@aol.com

The first 20% of the full text of this article appears below.


Paul A. Kurlansky, MD


Coronary artery bypass graft (CABG) surgery on a beating heart was introduced with suture techniques and local stabilization by Kolessov in 1967.1 However, cardiopulmonary bypass and cardioplegic arrest, with their ability to provide a quiet bloodless field for the construction of precise and delicate surgical anastomoses, offered compelling advantages compared with the off-pump approach and rapidly became more widely accepted.2 With the dramatic reduction of operative mortality throughout the ensuing decades, surgeons began to focus their attention on decreasing operative morbidity, especially conditions associated with neurologic and systemic inflammatory influences after CABG surgery. Traditionally, many of these sequelae have been ascribed to the use of cardiopulmonary bypass.

During the past decade, there has been a dramatic resurgence in the application of off-pump technology in CABG surgery. This has inspired remarkable advances in the techniques of localized tissue stabilization and a greater understanding of the physiology of beating heart mobilization and exposure. An avalanche of reports in the literature has demonstrated the early safety and efficacy of the procedure.3 More than 20% of CABG procedures performed nationwide apply off-pump technology. However, considerable controversy remains regarding the relative merits and long-term outcomes of this approach to coronary revascularization.4

One area of concern, and even greater uncertainty, surrounds the issue of the existence of a hypercoagulable state after off-pump CABG surgery. Are patients undergoing off-pump CABG surgery relatively more hypercoagulable postoperatively than their counterparts undergoing on-pump CABG surgery? Such a hypothesis is indeed reasonable in view of the acute phase activation of clotting factors that follow off-pump CABG surgery (as well as surgery in general) and the lack . . . [Full Text of this Article]






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