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Study Name

Aim of Study

Study Type

Study

Patient Population/Inclusion &

Endpoints

Statistical

P-Values & 95%

OR / HR / RR

Study Summary

Size

Exclusion Criteria

Analysis

CI

Reported

Inclusion Criteria

Exclusion

Primary

Secondary

Criteria

Endpoint

Endpoint

Renal failure

Identify the

Retrospective

649

All cardiac surgery

N/A

ARF, ARF-

N/A

Multivariate

Cardiac

Cardiac

Cardiac catheterization within 5

after cardiac

relationship

single center

patients on

D, hospital

catheterization

catheterization

d of cardiac operation, baseline

surgery:

between

dialysis, cardiac

mortality

within 5 d;

within 5 d OR:

preoperative renal dysfunction,

timing of

timing of

transplant, VAD,

p=0.010; 95% CI:

1.82; baseline

prolonged CPB time are

cardiac

preoperative

emergency, aortic

1.17 to 2.84;

GFR <60 mL/min

significant risk factors for ARF.

catheterizatio

cardiac

dissection.

baseline GFR

1.69.

n and other

catheterization

<60 mL/min;

perioperative

and incidence

p=0.047; 95% CI:

risk factors.

of

1.09 to 2.62

2007 (272)

postoperative

ARF

The effect of

To assess the

Single center

395

CABG on-pump

Patients on

ARF

Perioperative

Multivariate

1 d interval

<1 d interval OR:

CABG should be delayed in the

cardiac

effect of

retrospective

dialysis and

mortality,

p=0.07; 95% CI:

3.7; eClCr <60

presence of high contrast dose

angiography

timing of

salvage

ICU and

1.4 to 8.3; ClCr

mL/min; OR: 7.1

and preoperative renal

timing,

cardiac

operations,

hospital stay

<60 mL/min;

dysfunction for at least 5 d after

contrast

angiography

referred from

95% CI: 3 to 16;

cardiac catheter

media dose,

and prevalence

OSH.

p<0.001

and

of ARF after

preoperative

cardiac

renal function

surgery

on ARF after

CABG. 2010

(273)

Influence of

Identify the

Single center

423

Elective on-pump

Preop dialysis,

ARF

Multivariate

Same day cardiac

Same day cardiac

Cardiac surgery and

the Timing of

influence of

retrospective

cardiac surgery

emergent/urge

catheterization/su

catheterization

catheterization same d increased

Cardiac

timing of

nt surgery/off-

rgery p=0.039;

/surgery; OR:

risk 3-fold for ARF

Catheterizatio

cardiac

pump

95% CI: 1.06 to

3.05

n and the

catheter and

8.78

Amount of

ARF after

Contrast

cardiac

Media on

surgery

Acute Renal

Failure After

Study Name

Aim of Study

Study Type

Study

Patient Population/Inclusion &

Endpoints

Statistical Analysis

P

OR /

Study Summary

Study Limitations

Size

Exclusion Criteria

Reported

Values

HR /

& 95%

RR

CI

Inclusion

Exclusion

Primary

Secondary

Criteria

Criteria

Endpoint

Endpoint

Preoperative

To investigate

Retrospectiv

111

CABG patients

Not CABG

Bleeding

N/A

Greater percentage

p=0.001

N/A

Increased blood loss

Median time interval for

Use of

if the use of

e

patients

events

of patients on

and reoperative for

discontinued LMWH was

Enoxaparin

LMWH or

LMWH required

bleeding in the

21 h.

increases the

PLT inhibitors

mediastinal re-

LMWH group.

Risk of

increased the

exploration for

Postoperative

risk of

nonsurgical

Bleeding and

bleeding in

bleeding versus

reexploration

CABG.

control (17% vs.

in cardiac

0% , respectively).

surgery

patients. 2005

(275)

Preoperative

To investigate

Retrospectiv

1159

Patients

1) The patient

Bleeding

Re-exploration was

p=0.03

HR:

Enoxaparin

N/A

use of

if the use of

e

presented with a

received no

events

7.9% in the

2.6

administration within

enoxaparin

LMWH

diagnosis of UA

antithrombotic

enoxaparin group

48 h of surgery

compared

compared with

or non Q–wave

therapy (UFH or

and 3.7% in the

increases the risk of

with UFH

UFH increased

MI and (2) the

enoxaparin) within

UFH group.

reoperative bleeding.

increases the

the risk of

patient received

48 h of the

incidence of

bleeding in

antithrombotic

surgical procedure

re-exploration

cardiac

therapy with

and 2) follow-up

for

surgery

either UFH or

clinical data were

postoperative

enoxaparin

not available

bleeding after

within 48 h

open-heart

before

surgery in

proceeding to

patients who

surgery

present with

an ACS:

clinical

investigation

and reports.

2002 (276)

Effects of

To investigate

Retrospectiv

161

CABG patients

Not CABG

Bleeding

Compared with

p<0.05

N/A

LMWH given <12 h

N/A

preoperative

the effects of

e

patients

events

UFH group,

increased the

enoxaparin

LMWH on

LMWH, <12 group

transfusion rate and

vs. UFH on

bleeding

had higher

number of PRBC

bleeding

indices and

transfusion rate

transfused per patient

indices in

transfusion

(73.5% vs. 50.7%,

patients

rates in

respectively),

undergoing

patients

CABG. 2003

undergoing

(277)

cardiac

surgery

Preoperative

To investigate

Retrospectiv

64

CABG patients

Not CABG

Bleeding

N/A

62% of pts

p=0.8

N/A

LMWH given <10 h

Number of patients

use of

if the use of

e

patients

events

transfused in the

does not increase the

receiving LMWH was

enoxaparin is

LMWH

LMWH vs. 60% in

transfusion rate and

only 21. High transfusion

not a risk

increased the

the control

number of PRBC

rate in the control group.

factor for

risk of

transfused per patient

postoperative

bleeding in

bleeding after

CABG

CABG. 2003

(278)

Article Title

Aim of Study

Study

Patient

Patient Population/Inclusion & Exclusion

Endpoints

Statistical Analysis

95% CI;

OR/HR/

Study Summary

Type

Size

Criteria

Reported

P-Values

RR

Inclusion Criteria

Exclusion Criteria

Primary

Secondary

Endpoint

Endpoint

A

To compare

RCT

50

Patients who were

An age of <30 y or >80

Graft patency

Clinical outcomes

Patients in the on-pump

p=0.004

N/A

N/A

randomized

graft-patency

referred for

y; an indication for

group were more likely to

comparison

rates and

isolated, first-time

additional surgical

receive packed-cell

of off-pump

clinical

coronary-artery

procedures;

transfusion (p=0.004) or

and on-

outcomes in

surgery and who

documented stroke

clotting-product

pump multi-

off-pump

required at least 3

within the preceding 6

transfusion (p=0.002). The

vessel

surgery with

grafts were

mo; carotid-artery

mean blood loss was not

CABG.

conventional,

eligible.

stenosis of more than

significantly different

2004 (279)

"on-pump"

70%; documented MI

between the 2 groups (898

surgery.

in the preceding 3 mo;

mL in the on-pump group

poor LV function, with

and 1,031 mL in the off-

an EF <20%;

pump group).

pregnancy and breast-

feeding; an inability to

provide written

informed consent; and

a history of

complications after

diagnostic

angiography.

Early

To compare

Random

281

Patients were

Patients were excluded

Cardiac

Improvement in

The intraoperative use of

95% CI:

N/A

Concluded that in

outcome

the short term

ized

eligible if referred

in case of emergency or

outcome 1 mo

quality of life at 1

blood products was

4 to 17;

selected patients, off-

after off-

clinical

Multice

for first-time

concomitant major

after surgery

mo.

reduced in the off-pump

p<0.01

pump CABG is safe

pump vs.

outcomes of

nter

isolated coronary

surgery, Q-wave MI in

(defined as

group. The proportion of

and yields a short-term

on-pump

OPCAB with

Trial

bypass surgery and

the previous 6 w, or

survival free of

patients in whom blood

cardiac outcome

coronary

standard on-

an off-pump

poor LV function or if

CV events,

products were used during

comparable to that of

bypass

pump CABG.

procedure was

they were unlikely to

which included

surgery was almost 4 times

on-pump CABG.

surgery:

deemed technically

complete 1 y of follow-

stroke, MI, and

lower in the off-pump

results from

feasible.

up or unable to give

coronary

group (3% for OPCAB vs.

a

informed consent.

intervention).

13% for on-pump CABG,

randomized

There were no

p<0.01).

study. 2001

restrictions as to age.

(280)

Early and

To pool the

Pooled

401

Patients

Recent MI within 1

The primary

Noncardiac events,

Analyses of combined data

95% CI:

RR: 0.36

In general, study

midterm

results of 2

outcom

undergoing off-

mo; had a history of

endpoint for this

such as chest or

from both trials showed

0.26 to

concluded off-pump

outcome

RCT to assess

e of 2

pump or on-pump

supraventricular

pooled analysis

wound infection, and

transfusion of red blood

0.51;p<0.

coronary surgery

after off-

midterm

RCT

CABG.

arrhythmia; had a

was all cause

neurological events.

was 31% lower in OPCAB

0001

significantly lowers in-

pump and

outcomes of

(which

previous CABG; had

mortality or a

pages compared to on-

hospital morbidity

on-pump

OPCAB.

compar

renal or respiratory

cardiac-related

pump CABG.

without compromising

surgery in

ed short

impairment; or had a

event at

outcome in the first 1 to

Beating

term

previous stroke, TIA,

midterm follow-

3 y after surgery

Heart

morbidi

or coagulopathy

up (1 to 3 y after

compared with

Against

ty of

present.

surgery).

conventional on-pump

Cardioplegic

OPCAB

coronary surgery.

Arrest

vs. on-

Studies

pump

(BHACAS1

CABG)

and 2): a

to

pooled

assess

analysis of 2

midterm

RCTs. 2002

outcom

(222)

es.

OPCAB

To compare

RCT

200

Patients referred

Patients in cardiogenic

Completeness of

In-hospital and 30-d

Patients undergoing

p=0.0073

OR: 2.42

In general, when

grafting

completeness

for elective

shock and those

revascularizatio

outcomes, LOS,

OPCAB received fewer

compared with

provides

of

primary CABG

requiring preoperative

n.

transfusion

units of blood, were more

conventional CABG

complete

revascularizati

IABP counterpulsation

requirements, and

likely to avoid transfusion

with CPB, OPCABG

revasculariz

on, clinical

were excluded from the

extent of myocardial

altogether and had a higher

achieved similar

ation with

outcomes, and

study for cardiac

injury.

hematocrit at discharge.

completeness of

reduced

resource use in

reasons. Patients who

CPB was an independent

revascularization,

myocardial

unselected

had chronic renal

predictor of transfusion

similar in-hospital and

injury,

patients

insufficiency with a

(OR: 2.42; p=0.0073) by

30-d outcomes, shorter

transfusion

referred for

creatinine level greater

multivariate analysis.

LOS, reduced

requirements

elective,

than 2.5 mg/dL were

transfusion

, and LOS: a

primary

eligible for enrollment

requirement, and less

prospective

CABG

in the study but were

myocardial injury.

randomized

randomly

exempt from having

comparison

assigned to

postoperative cardiac

of 200

undergo

angiography

unselected

OPCAB with

performed.

patients

an Octopus

undergoing

tissue

off-pump vs.

stabilizer

conventional

(Medtronic,

coronary

Inc,

artery

Minneapolis,

bypass

Minn) or

grafting

CABG with

(281).

CPB.

Complete

To evaluate

RCT

80

Inclusion criteria

Diffuse disease,

Completeness of

Parameters of

Although no significant

p=NS

N/A

In general, the study

revasculariz

the feasibility

were a normal or

ventricular

revascularizatio

clinical outcome

differences in bleeding

concluded OPCAB is

ation in

of CABG

almost unimpaired

hypertrophy, and

n

complications were

effective for complete

coronary

without CPB

LVEF and

cardiac enlargement

reported, 1 (2.5%)

revascularization in the

artery

to achieve

presence of

reexploration occurred

majority of selected

bypass

complete

coronary

because of bleeding in a

low-risk patients,

grafting with

revascularizati

multivessel

patient without CPB and 2

although the rate of

and without

on as

disease.

(5.0%) reexplorations

incomplete

CPB. 2001

compared with

occurred in patients with

revascularization in this

(282)

the standard

CPB.

early series of CABG

operation with

without CPB was

CPB in

higher.

selected low-

risk patients.

Does

To determine

Meta-

3,369

Studies were

Hybrid (i.e., OPCAB

All-cause

Postoperative

OPCAB significantly

95% CI:

OR: 0.43

In general, selected

OPCAB

whether

Analysi

included if they

plus balloon

mortality at 30

incidence of stroke,

decreased transfusion

0.29 to

short-term and mid-

reduce

OPCAB

s

met each of the

angioplasty) and

d, 6 mon, and

acute MI, AF, renal

requirements.

0.65;

term clinical and

mortality,

reduces

following

robotically assisted

>1 y.

failure, need for

p<0.0001

resource outcomes were

morbidity,

mortality,

conditions:

surgery studies were

inotropes, need for

improved compared

and resource

morbidity, or

randomized

excluded.

intraaortic balloon

with conventional

utilization

resource

allocation to

pump,

CABG.

when

utilization

OPCAB on the

mediastinitis/wound

compared

when

beating heart vs.

infection, respiratory

with

compared with

conventional

infections, angina

conventional

standard

CABG on the

recurrence,

coronary

CABG.

asystolic heart with

reintervention for

artery

CPB circuit, adult

ischemia, restenosis,

bypass? A

patients undergoing

need for

meta-

singleor multiple-

transfusions,

analysis of

vessel bypass, and

reexploration for

randomized

reporting at least 1

bleeding,

trials. 2005

pertinent clinical or

neurocognitive

(283)

economic outcome.

dysfunction, duration

Off-pump studies

of ventilation, ICU

using minimally

LOS, hospital LOS,

invasive direct

hospital costs, and

coronary artery

QOL.

bypass with

thoracotomy and

studies allowing

for ventricular

assist devices were

included with the

intent of

subanalyzing these

groups. Blinded

and unblinded

studies were

included.

Impact of

To evaluate

Review

N/A

All blinded or

Studies reporting on

Blood loss.

Transfusion

N/A

N/A

N/A

Evidence clearly

off-pump

current best

article

unblinded RCTs

outcomes of hybrid

requirements

(values

suggests that there is

CABG on

available

on

comparing OPCAB

(i.e., OPCAB plus

for

less bleeding with off-

postoperativ

evidence from

RCT's.

or MIDCAB on the

balloon angioplasty)

individua

pump procedures

e bleeding:

RCTs to assess

beating heart with

procedures,

l studies

compared with CPB

current best

the impact of

conventional

robotically assisted

reported)

and there is less need

available

OPCAB on

CABG on CPB

surgery or using

for blood products.

evidence.

postoperative

using cardioplegic

circulatory assist

2006 (284)

blood loss and

arrest, recruiting

devices were excluded.

transfusion

adult patients

requirements.

undergoing single-

or multiple-vessel

bypass, and

reporting at least 1

pertinent clinical or

economic outcome

were retrieved. Out

of these, RCTs

reporting on

postoperative blood

loss were included

for this systematic

review.

Study

Aim of

Study Type

Study

Patient Population/Inclusion

Endpoints

Statistical Analysis Reported

P Values &

OR / HR

Study Summary

Name

Study

Size

& Exclusion Criteria

95% CI

/ RR

Inclusion

Exclusion

Primary

Secondary

Criteria

Criteria

Endpoint

Endpoint

Blood

To define

Comparison of

1,261

Patients

Patients not

Incidence

ICU and

N/A

p<0.001

N/A

Adherence to defined transfusion

conservatio

strict

prospective data

undergoing

undergoing

of

hospital LOS

criteria alone is a simple, safe, and

n in

transfusion

with retrospective

isolated

isolated

postoperati

and

effective strategy for decreasing

coronary

criteria as the

data (data is

primary

primary

ve

reoperation

blood product utilization.

artery

sole blood

regarding blood

CABG.

CABG.

transfusion

for bleeding.

surgery.

conservation

product usage).

.

1994 (285)

strategy.

Efficacy of

To determine

RCT

92

Adult men

Patients

Transfusio

ICU blood

Adherence to a coagulation

p=0.0002

N/A

ICU mediastinal blood loss was

a simple

if coagulation

and

undergoing

n

loss.

test-based transfusion

(for FFP

significantly less in the algorithm

intraoperati

test-based

nonpregnant

nonelective

requiremen

algorithm in cardiac surgery

transfusion);

group. Multivariate analysis

ve

algorithms

adult

surgery or

ts.

patients with abnormal

p=0.0001

demonstrated that transfusion

transfusion

may reduce

women

undergoing

bleeding after CPB reduced

(for platelet

algorithm use resulted in reduced

algorithm

transfusion of

scheduled

surgery

nonerythrocyte allogeneic

transfusion)

ICU blood loss. The control group

for

nonerythrocyt

for elective

without CPB.

transfusions in the operating

also had a significantly greater

nonerythro

e allogeneic

cardiac

room and ICU blood loss. The

incidence of surgical reoperation of

cyte

blood in

surgery

transfusion algorithm group

the mediastinum for bleeding

component

patients with

requiring

received less allogeneic fresh

(11.8% vs. 0%; p=0.032).

utilization

abnormal

CPB.

frozen plasma in the operating

after CPB.

bleeding.

room after CPB (median: 0

2001 (286)

units; range: 0 to 7 units) than

the control group (median: 3

units; range: 0 to 10 units)

(p=0.0002). The median

number of platelet units

transfused in the operating

room after CPB was 4 (range:

0 to 12) in the algorithm group

compared with 6 (range: 0

to18) in the control group

(p=0.0001).

Reduced

Determine if

Pilot study to

60

Patients

Patients not

Reduced

Chest tube

Ten patients in the regular

p<0.005

N/A

Concluded that intraoperative

haemostati

the

investigate the

undergoing

undergoing

total

output

clinical group received a total

monitoring of coagulation in the

c factor

heparinase-

use of an

cardiac

cardiac

exposure

of 16 units of FFP and 9

anticoagulated patient can be used to

transfusion

modified

algorithm.

surgery.

surgery.

to

platelet concentrates

guide treatment.

using

thrombelasto

hemostatic

compared with 5 patients

heparinase-

gram using

component

transfused with 5 units of FFP

modified

anticoagulate

therapies.

and 1 platelet concentrate in

thrombelas

d blood from

the algorithm group. 12-h

tography

patients

chest tube losses [algorithm

during

during

group 470 (295 to 820) mL,

CPB. 2001

cardiac

clinically managed group 390

(287)

surgery could

(240 to 820) ml (median,

guide

quartile values)] were not

treatment

significantly different between

with

groups despite the 3-fold

haemostatic

reduction in the use of

components.

haemostatic products,