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OPCAB without transfusion
Weon-Yong Lee1, Ho-Hyun Ko1, Sung Jun Kim1, Kun-Il Kim1, Hyoung-Soo Kim2, Sung-Woo Cho3.
1Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Korea, Republic of, 2Chuncheon Sacred Heart Hospital, Chin-cheon, Kang-won do, Korea, Republic of, 3Kangdong Sacred Heart Hospital, Seoul, Korea, Republic of.

OBJECTIVE: Transfusion is strictly limited in USA, but generous in Korea. Also there is lack of interest for open heart surgery without transfusion. In this study, we estimate success rate according to hemoglobin(Hb) level for OPCAB without transfusion, cut-off point of Hb and risk factors of transfusion.
METHODS: Among 112 consecutive patients who had underdone OPCAB From 2007 to 2011, we excluded 10 CRF and 3 death. We estimate success rate by pre-operative Hb in 99 patients. And in patients with pre op. Hb >11, we performed retrospective study between transfusion and non-transfusion group to evaluate the risk factors for transfusion. Trigger points of transfusion are Hb < 8.0 , and < 10.0 in the presence of bleeding or unstable vital sign. We have used blood saving protocols such as intraoperative autologous donation(IAD), frequent infusion of Cell saver reservoirs, etc.
RESULTS: 75 of 99 (75.8%) patients had undergone OPCAB without transfusion. Especially in patient with Hb 11 or more, significantly higher success rate (85.0%) has been observed and the reasons of transfusion are mainly bleeding or unstable vital sign. Risk factors of transfusion are Age, Diagonsis of AMI, clopidegrel, pre op. platelet, albumin, post op. CTD drain and ventilator time.
CONCLUSIONS: The patients with pre op. Hb > 11.0 improve chances of OPCAB without transfusion. The Risk factors of transfusion are age, AMI, clopidogrel, platelet, albumin. Also the causes of transfusion are correctable (mainly unstable vital sign, bleeding). OPCAB without transfusion can be performed safely with proper patient selection, various blood salvage methods, and meticulous bleeding control.

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