Stefano D'Alessandro

Preoperative very short-term, high-dose erythropoietin administration diminishes blood transfusion rate in off-pump coronary artery bypass: A randomized blind controlled study

OBJECTIVE Human recombinant erythropoietin has been used to obtain a rapid increase in red blood cells before surgery. Previously, the shortest preparatory interval has been 4 days, but at the European Hospital only 2.4 days on average separate hospitalization and surgery. We therefore proposed a randomized blind trial to test the efficacy of high-dose erythropoietin for very short-term administration. METHODS All patients presenting with a diagnosis of isolated coronary vessel disease were randomized to either erythropoietin therapy or a control group. Patients with a creatinine level greater than 2 mg/dL or hemoglobin level greater than 14.5 g/dL were excluded. Hemoglobin values were collected preoperatively and on postoperative days 1 and 4. Blood loss and blood transfusion rate were recorded at the time of discharge. RESULTS We enrolled 320 consecutive patients in the study. No significant difference was found in preoperative parameters, postoperative blood loss, or mean preoperative hemoglobin levels. On postoperative day 4, mean hemoglobin was 15.5% higher in the erythropoietin group (10.70 +/- 0.72 g/dL vs 9.26 +/- 0.71 g/dL; P < .05). This group required 0.33 units of blood per patient, whereas the controls required 0.76 units per patient (risk ratio 0.43, P = .008). CONCLUSION A significant reduction in transfusion rate and a significant increase in hemoglobin values were observed in the erythropoietin group. No adverse events related to erythropoietin administration were recorded. A very short preoperative erythropoietin administration seems to be a safe and easy method to reduce the need for blood transfusions.

Minimally Invasive Coronary Artery Bypass Grafting on the Beating Heart: The European Experience

The prospect of grafting the internal mammary artery (IMA) to the left anterior descending (LAD) artery via a thoracotomy without the aid of cardiopulmonary bypass (CPB) was first explored by Kolessov in 1967 (1), and further applied by Favaloro (2), Garrett (3), Trapp (4), and others. The early wave of enthusiasm for this technique soon wavered with the widespread availability of CPB and cardioplegia, which allowed for a motionless and bloodless operative field. The unequivocal and widespread success of conventional coronary artery bypass grafting (CABG) limited the use of unsupported bypass grafting. Two developments in the early 1990s revived the technique of myocardial revascularization without CPB: (1) the emergence of minimally invasive technology applicable to the chest, and (2) the promising results of “pumpless” bypass grafting reported by a number of authors (5–7). In our opinion, the definition of minimally invasive cardiac surgery encompasses all approaches that avoid cardiopulmonary bypass, regardless of mode of surgical access