CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 2, March/April 2022 AFRICA 75 aortic balloon pump or extracorporeal membrane oxygenation were required, were also excluded. All anti-aggregant and anticoagulant treatments, except acetylsalicylic acid, were stopped five days before the operation. Written informed consent was obtained from all participants. The study was approved by the institutional review board and was conducted in accordance with the Helsinki declaration (No: 48670771-514.10). All CABG procedures were performed by the same surgical team in a standardised method utilising an on-pump technique. Arterial and venous catheters were inserted into the radial artery and right jugular vein before sternotomy. Blood pressure, central venous pressure, urine output and oxygenation were monitored throughout the surgery. All patients underwent standard median sternotomy under general anaesthesia. Grafts were prepared after heparinisation (300 IU/kg). After placement of the Favalaro retractor, the left internal mammary artery was harvested in the form of pedunculated grafts in all patients by the use of electrocautery and haemoclips. Saphenous vein grafts were harvested endoscopically (because of fast wound healing) and were grafted to the coronary arteries employing the end-to-side anastomotic technique. The Stockert S5 heart–lung machine and Terumo FX 25 oxygenators were used in the operations. Also, all lines were heparin coated. Heparin was neutralised at the end of the operations by giving 60–80 mg of protamine for every 100 IU of heparin. An epicardial pacing wire was then positioned on the anterior cardiac surface and mediastinal and thoracic cannulas were placed for drainage. The sternum was closed with surgical steel wires as a complete layer. From the first postoperative day, all patients received a lifelong daily maintenance dose of 100 mg of acetylsalicylic acid. Complete blood count, prothrombin time (PT/INR), partial thromboplastin time and fibrinogen level were measured at baseline (pre-operatively), following the completion of the surgery, at the postoperative first and third days, and before discharge. The IPC and IPF were also measured pre-operatively, following completion of the surgery and at the postoperative first, third and fifth days. EDTA-anticoagulated whole-blood samples were used to measure the platelet count and percentage of IPF (IPF%) using a Sysmex XN-9000 analyser (Sysmex, Kobe, Japan).7 Demographic data, details of the surgical procedure, operation time, aortic cross-clamp time, coagulation test results, mean platelet volume, platelet count, IPC and IPF, erythrocyte and whole-blood transfusions, and length of hospital stay were recorded. The association between need for transfusion and the values of IPC, IPF, MPV and platelet count was the primary outcome measure of this study. Statistical analysis All analyses were performed on SPSS v26 (SPSS Inc, Chicago, IL, USA). The Wilcoxon test was used for the normality check. Data are given as mean ± standard deviation or median (first to third quartile) for continuous variables according to normality of distribution, and as frequency (percentage) for categorical variables. Repeated measurements were analysed with the Friedman’s analysis of variances by ranks since parametric test assumptions were not met. The Spearman test was used in correlation analysis. All p < 0.05 values were accepted as statistically significant results. Results One hundred and forty-nine patients meeting the inclusion criteria were enrolled in the study (mean age 64 ± 11 years, 77.86% Table 1. Summary of patients’ characteristics Age (years) 64 ± 11 Gender, n (%) Female 33 (22.14) Male 116 (77.86) Body mass index (kg/m2) 27.44 (24.58–29.41) Co-morbidities, n (%) 131 (88.00) Hypertension 98 (66.00) Cerebrovascular accident 6 (4.00) COPD 15 (10.00) Diabetes mellitus 108 (72.00) Hyperlipidaemia 48 (32.00) Smoking, n (%) 95 (64.00) Pre-operative EF (%) 55 (45–60) Pre-operative GFR (ml/min/1.73 m2) 90 (66.42–90) ≤ 90, n (%) 71 (48.00) > 90, n (%) 78 (52.00) Data are given as mean ± standard deviation or median (1st quartile – 3rd quartile) for continuous variables according to normality of distribution and as frequency (percentage) for categorical variables. COPD: chronic obstructive pulmonary disease, EF: ejection fraction, GFR: glomerular filtration rate. Table 2. Summary of intra-operative and postoperative characteristics Duration of operation (min) 290.70 ± 53.02 Duration of ACC (min) 65.5 (56–76) Total perfusion time (min) 118.64 ± 28.26 Blood components (intra-operative) 0 (0–2) Erythrocyte suspension (units) 1 35 ≥ 2 22 Postoperative drainage (ml) 12th hour 476 (50–1100) 24th hour 573 (150–1350) Blood components (postoperative, ICU) 2 (1–4) Erythrocyte suspension (units) 1 55 2 23 ≥ 3 19 Length of stay in ICU (days) 2 (2–3) Length of stay in hospital (days) 6 (6–8) Morbidity, n (%) 6 (4.00) Revision, n (%) 12 (8.00) Sternal dehiscence, n (%) 6 (4.00) Bleeding, n (%) 6 (4.00) Low output, n (%) 0 (0.00) Postoperative complications, n (%) Renal dysfunction 3 (2.00) Dialysis 0 (0.00) Atrial fibrillation 12 (8.00) Cerebrovascular accident 0 (0.00) Early mortality 3 (2.00) Data are given as mean ± standard deviation or median (1st quartile – 3rd quartile) for continuous variables according to normality of distribution and as frequency (percentage) for categorical variables. CABG: coronary artery bypass graft, ACC: aortic cross-clamp, ICU: intensive care unit.
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