Abstract
OFF-PUMP ARTERIAL GRAFT PATENCY: COMPARISON BETWEEN INTRAOPERATIVE HEPARIN INFUSION AND HEPARIN BOLUS PROTOCOL

Kamales Kumar Saha*, MCh, Kakalee K. Saha, Mphil, Vikram Vardhan, PDCC, Pravinchandra K. Shroff, MD, Aditi Sawant, MD, Dinesh Kumar Sangwan, MD, Pravin Lovhale, DM and
Kshiti Shah, DNB

ABSTRACT

Background: Off-pump coronary artery bypass grafting (OPCAB) techniques continue to evolve. Optimum level of intraoperative activated clotting time (ACT) during OPCAB is debatable. In this study we present comparison of angiographic graft patency (computerized tomography angiography or catheter angiography) of OPCAB using two different intraoperative antithrombotic protocols –heparin bolus and heparin infusion. Aim of this study to compare angiographic patency rate of grafts between the two intraoperative anticoagulation techniques. Methods: Total 1182 consecutive isolated CABG patients operated by a single surgeon were included in the study. Out of these 179 patients had 182 angiography studies which were available with us. Repeat study of 3 patients were excluded from the study. So the operative record and postoperative angiography data of 179 patients were analyzed. Results: There were 24 patients in the heparin bolus group and 155 patients in heparin infusion group. There was no significant difference in graft patency between the groups. Conclusion: In our study there is no difference in graft patency between heparin infusion and heparin bolus group in spite of maintaining lower intraoperative ACT in infusion group. We conclude that lower level of anticoagulation during OPCAB maintained using heparin infusion (ACT between 200-300 seconds) is safe during OPCB and does not adversely affect graft patency of arterial grafts. However further study is warranted about safety of this protocol for vein grafts used during OPCAB.

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