Fibrin Clot Properties and Blood Loss Following Coronary Artery By-pass Grafting

Association of Fibrin Clot Properties With Blood Loss Following Coronary Artery By-pass Grafting - Does Surgical Technique of Left Internal Mammary Artery Harvesting Matter

Up to 15% of operations in cardio-pulmonary by-pass are complicated by excessive postoperative blood loss, which negatively affects the outcomes. Recently, it has been demonstrated that fibrin clot susceptibility to lysis is a modulator of postoperative blood loss after cardiac surgery for aortic stenosis. Earlier, a preliminary study showed a negative association of postoperative blood loss after coronary artery by-pass grafting (CABG) with fibrin clot lysis time, reflecting susceptibility to fibrinolysis. In CABG, postoperative blood loss may depend on the operative technique with respect to left internal mammary artery (LIMA) harvesting. LIMA is taken down in virtually all CABG procedures, but harvesting technical details remain at surgeons discretion (skeletonization without opening the pleural cavity vs. pedicled graft with pleura wide open). The investigators decided to test the hypothesis that fibrin clot properties modulate the postoperative drainage following CABG strongly enough to attenuate the influence of surgical technique by randomizing the patients undergoing CABG with regard to LIMA harvesting technique.

Coronary Artery Disease, Internal Mammary-Coronary Artery Anastomosis, Coronary Artery Bypass, Blood Loss, Postoperative, Fibrinolysis

Coronary Artery By-pass Grafting, CABG, Fibrin, Clot Lysis Time, CLT, Bleeding, Drainage, Rethoracotomy

The patient will be blinded to LIMA harvesting technique. The laboratory technicians will be blinded to LIMA harvesting technique.

In patients in this arm the left internal mammary artery will be skeletonized without opening of the left pleural cavity during CABG.

In patients in this arm the left internal mammary artery will be harvested as a pedicled graft with wide opening of left pleural cavity.

Standard CABG - no different form any other procedure of this type except LIMA will be skeletonized without opening the pleura

Standard CABG - no different form any other procedure of this type except LIMA will be taken down as a pedicled graft with opening the pleura

Change in myocardial necrosis biomarkers (Troponin T, creatine kinase) during first 48 hours postoperatively

Inclusion Criteria: Angiographically confirmed coronary artery disease Heart Team qualification for first time elective coronary artery by-pass grafting No significant valvular disease or congenital heart disease Normal sinus rhythm on ECG Continued aspirin in perioperative period Exclusion Criteria: Need for any concomitant cardiac procedure St. p. percutaneous coronary intervention within preceding 3 months Any previous cardiac surgery Known bleeding diathesis Acute cardiovascular incident within preceding 3 months Heart failure with left ventricular ejection fraction <30% Any autoimmune disease Any acute infection Known neoplasm Any thyroid disease Treatment with any thienopyridine, oral anticoagulant, heparin or any non-steroid anti-inflammatory agent other than aspirin Mental disorder Severe comorbidities (liver failure, renal failure on hemodialysis) Lacking consent