Antithrombotic drug removal with hemoadsorption during off-pump coronary artery bypass grafting
Abstract Background Patients requiring coronary artery bypass grafting (CABG) are often loaded with antithrombotic drugs (AT) and are at an increased risk for perioperative bleeding complications. Active AT removal by a hemoadsorption cartridge integrated in the cardiopulmonary bypass circuit is inc...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-04-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-024-02772-1 |
| _version_ | 1797199173578129408 |
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| author | Helmut Mair Stephanie Ulrich Dow Rosenzweig Johannes Goeppl Christopher Jurma Ferdinand Vogt Benedikt Baumer Frank Vogel Peter Lamm |
| author_facet | Helmut Mair Stephanie Ulrich Dow Rosenzweig Johannes Goeppl Christopher Jurma Ferdinand Vogt Benedikt Baumer Frank Vogel Peter Lamm |
| author_sort | Helmut Mair |
| collection | DOAJ |
| description | Abstract Background Patients requiring coronary artery bypass grafting (CABG) are often loaded with antithrombotic drugs (AT) and are at an increased risk for perioperative bleeding complications. Active AT removal by a hemoadsorption cartridge integrated in the cardiopulmonary bypass circuit is increasingly used in this setting to reduce bleeding, and herein we describe the extension of this application in patients on AT undergoing off-pump coronary artery bypass (OPCAB). Methods Ten patients (80% male; mean age: 67.4 ± 9.2years) were treated with ticagrelor (eight patients), rivaroxaban and ticagrelor (one patient), and rivaroxaban (one patient) prior to OPCAB surgery. AT’s were discontinued one day before surgery in nine patients and on the day of surgery in one patient, and all patients were also on aspirin. The cohort mean EuroSCORE-II was 2.9 ± 1.5%. A hemoadsorption cartridge was integrated into a dialysis device (n=4) or a stand-alone apheresis pump (n=6) periprocedural, for a treatment time of 145 ± 33 min. Outcome measures included bleeding according to Bleeding Academic Research Consortium (BARC)-4 and 24-hour chest-tube-drainage (CTD). Results Mean operation time was 184 ± 35 min. All patients received a left internal thoracic artery with a mean of 2.3 ± 0.9 total grafts. One patient had a BARC-4 bleeding event and there were no surgical re-explorations for bleeding. Mean 24-hours CTD was 680 ± 307mL. During follow-up of 19.5 ± 17.0 months, none of the patients died or required further reinterventions. No device-related adverse events were reported. Conclusions Hemoadsorption via a stand-alone apheresis pump during OPCAB surgery was feasible and safe. This innovative and new approach showed favorable bleeding rates in patients on antithrombotic drugs requiring bypass surgery. |
| first_indexed | 2024-04-24T07:11:33Z |
| format | Article |
| id | doaj.art-237be47716434243937fc00e4e310319 |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-04-24T07:11:33Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-237be47716434243937fc00e4e3103192024-04-21T11:30:05ZengBMCJournal of Cardiothoracic Surgery1749-80902024-04-011911710.1186/s13019-024-02772-1Antithrombotic drug removal with hemoadsorption during off-pump coronary artery bypass graftingHelmut Mair0Stephanie Ulrich1Dow Rosenzweig2Johannes Goeppl3Christopher Jurma4Ferdinand Vogt5Benedikt Baumer6Frank Vogel7Peter Lamm8Department of Cardiac Surgery, Artemed Klinikum München Süd Am Isarkanal 30Department of Cardiology, Benedictus Krankenhaus TutzingDepartment of Cardiac Surgery, Artemed Klinikum München Süd Am Isarkanal 30Department of Cardiac Surgery, Artemed Klinikum München Süd Am Isarkanal 30Department of Cardiac Surgery, Artemed Klinikum München Süd Am Isarkanal 30Department of Cardiac Surgery, Artemed Klinikum München Süd Am Isarkanal 30Department of Cardiac Surgery, Artemed Klinikum München Süd Am Isarkanal 30Department of Anesthesiology, Artemed Klinikum München SüdDepartment of Cardiac Surgery, Artemed Klinikum München Süd Am Isarkanal 30Abstract Background Patients requiring coronary artery bypass grafting (CABG) are often loaded with antithrombotic drugs (AT) and are at an increased risk for perioperative bleeding complications. Active AT removal by a hemoadsorption cartridge integrated in the cardiopulmonary bypass circuit is increasingly used in this setting to reduce bleeding, and herein we describe the extension of this application in patients on AT undergoing off-pump coronary artery bypass (OPCAB). Methods Ten patients (80% male; mean age: 67.4 ± 9.2years) were treated with ticagrelor (eight patients), rivaroxaban and ticagrelor (one patient), and rivaroxaban (one patient) prior to OPCAB surgery. AT’s were discontinued one day before surgery in nine patients and on the day of surgery in one patient, and all patients were also on aspirin. The cohort mean EuroSCORE-II was 2.9 ± 1.5%. A hemoadsorption cartridge was integrated into a dialysis device (n=4) or a stand-alone apheresis pump (n=6) periprocedural, for a treatment time of 145 ± 33 min. Outcome measures included bleeding according to Bleeding Academic Research Consortium (BARC)-4 and 24-hour chest-tube-drainage (CTD). Results Mean operation time was 184 ± 35 min. All patients received a left internal thoracic artery with a mean of 2.3 ± 0.9 total grafts. One patient had a BARC-4 bleeding event and there were no surgical re-explorations for bleeding. Mean 24-hours CTD was 680 ± 307mL. During follow-up of 19.5 ± 17.0 months, none of the patients died or required further reinterventions. No device-related adverse events were reported. Conclusions Hemoadsorption via a stand-alone apheresis pump during OPCAB surgery was feasible and safe. This innovative and new approach showed favorable bleeding rates in patients on antithrombotic drugs requiring bypass surgery.https://doi.org/10.1186/s13019-024-02772-1HemoadsorptionOPCABAntithrombotic removalCardiac surgeryCytosorbTicagrelor |
| spellingShingle | Helmut Mair Stephanie Ulrich Dow Rosenzweig Johannes Goeppl Christopher Jurma Ferdinand Vogt Benedikt Baumer Frank Vogel Peter Lamm Antithrombotic drug removal with hemoadsorption during off-pump coronary artery bypass grafting Journal of Cardiothoracic Surgery Hemoadsorption OPCAB Antithrombotic removal Cardiac surgery Cytosorb Ticagrelor |
| title | Antithrombotic drug removal with hemoadsorption during off-pump coronary artery bypass grafting |
| title_full | Antithrombotic drug removal with hemoadsorption during off-pump coronary artery bypass grafting |
| title_fullStr | Antithrombotic drug removal with hemoadsorption during off-pump coronary artery bypass grafting |
| title_full_unstemmed | Antithrombotic drug removal with hemoadsorption during off-pump coronary artery bypass grafting |
| title_short | Antithrombotic drug removal with hemoadsorption during off-pump coronary artery bypass grafting |
| title_sort | antithrombotic drug removal with hemoadsorption during off pump coronary artery bypass grafting |
| topic | Hemoadsorption OPCAB Antithrombotic removal Cardiac surgery Cytosorb Ticagrelor |
| url | https://doi.org/10.1186/s13019-024-02772-1 |
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