HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Paul A. Kurlansky Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kurlansky, P. A. Search for Related Content PubMed PubMed Citation Articles by Kurlansky, P. A. Related Collections Cardiac - physiology Coronary disease Minimally invasive surgery

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?

^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]

This article has been cited by other articles:

				F. Bednar, P. Osmancik, T. Vanek, H. Mocikova, M. Jares, Z. Straka, and P. Widimsky Platelet activity and aspirin efficacy after off-pump compared with on-pump coronary artery bypass surgery: results from the prospective randomized trial PRAGUE 11-Coronary Artery Bypass and REactivity of Thrombocytes (CABARET). J. Thorac. Cardiovasc. Surg., October 1, 2008; 136(4): 1054 - 1060. [Abstract] [Full Text] [PDF]

				B. R. Untch, W. P. Jeske, J. Schwartz, S. Botkin, M. Prechel, J. M. Walenga, and M. Bakhos Inflammatory and Hemostatic Activation in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting Clinical and Applied Thrombosis/Hemostasis, April 1, 2008; 14(2): 141 - 148. [Abstract] [PDF]

				M. E. Halkos, W. A. Cooper, R. Petersen, J. D. Puskas, O. M. Lattouf, J. M. Craver, and R. A. Guyton Early Administration of Clopidogrel Is Safe After Off-Pump Coronary Artery Bypass Surgery. Ann. Thorac. Surg., March 1, 2006; 81(3): 815 - 819. [Abstract] [Full Text] [PDF]

				D. Paparella, A. Galeone, M. T. Venneri, M. Coviello, G. Scrascia, N. Marraudino, M. Quaranta, L. de Luca Tupputi Schinosa, and S. J. Brister Activation of the coagulation system during coronary artery bypass grafting: Comparison between on-pump and off-pump techniques J. Thorac. Cardiovasc. Surg., February 1, 2006; 131(2): 290 - 297. [Abstract] [Full Text] [PDF]

				A. Parolari, F. Alamanni, G. Polvani, M. Agrifoglio, Y. B. Chen, S. Kassem, F. Veglia, E. Tremoli, and P. Biglioli Meta-Analysis of Randomized Trials Comparing Off-Pump With On-Pump Coronary Artery Bypass Graft Patency Ann. Thorac. Surg., December 1, 2005; 80(6): 2121 - 2125. [Abstract] [Full Text] [PDF]

				A. Parolari, L. Mussoni, M. Frigerio, M. Naliato, F. Alamanni, A. Galanti, G. Fiore, F. Veglia, E. Tremoli, P. Biglioli, et al. Increased prothrombotic state lasting as long as one month after on-pump and off-pump coronary surgery J. Thorac. Cardiovasc. Surg., August 1, 2005; 130(2): 303 - 308. [Abstract] [Full Text] [PDF]

				J. Pepper Controversies in Off-pump Coronary Artery Surgery Clin. Med. Res., February 1, 2005; 3(1): 27 - 33. [Abstract] [Full Text] [PDF]

				V. Casati, S. Benussi, L. Sandrelli, M. A. Grasso, S. Spagnolo, and A. D'Angelo Intraoperative Moderate Acute Normovolemic Hemodilution Associated with a Comprehensive Blood-Sparing Protocol in Off-Pump Coronary Surgery Anesth. Analg., May 1, 2004; 98(5): 1217 - 1223. [Abstract] [Full Text] [PDF]

				J. D. Puskas, W. H. Williams, E. M. Mahoney, P. R. Huber, P. C. Block, P. G. Duke, J. R. Staples, K. E. Glas, J. J. Marshall, M. E. Leimbach, et al. Off-Pump vs Conventional Coronary Artery Bypass Grafting: Early and 1-Year Graft Patency, Cost, and Quality-of-Life Outcomes: A Randomized Trial JAMA, April 21, 2004; 291(15): 1841 - 1849. [Abstract] [Full Text] [PDF]