jsmc-10162

PREDICTORS OF RE-EXPLORATION FOR BLEEDING AFTER CORONARY ARTERY BYPASS GRAFT AND VALVE SURGERY

Amanj K Mohammad a

a Unit of Thoracic and Cardiovascular Surgery,Department of Surgery, College of Medicine, University of Sulaimani.

Submitted: 14/1/2018; Accepted: 8/7/2018; Published 15/10/2018

DOI Link: https://doi.org/10.17656/jsmc.10162

ABSTRACT

Background

A significant number of patients undergoing cardiac surgery require re-exploration for postoperative bleeding.

Objectives

The aim of this study is to find out the predictors of re-exploration for such bleeding.

Patients and Methods

Over a 5-year period (January 2010-December 2014) 1,565 patients underwent open-heart surgery in Slemani Cardiac Hospital, Sulaimaniyah, Iraq. Fifty seven patients (3.6%) were identified as having a significant bleeding after coronary artery bypass graft (CABG) and/or valve operations requiring urgent exploration within few hours. The medical records of these patients were retrospectively reviewed.

Results

There were 36 males and 21 females. The mean age was 61.8±7.5 years. The majority of patients had CABG (n=41, 71.9%) while the remainder 16 patients (28.1%) had valve operations. The mean time interval between the primary cardiac operation and re-exploration was 3.17 ± 1.5 hours. Twenty nine patients (50.9%) had a drop in hemoglobin level. Thirteen patients (22.8%) had a fall in arterial blood pressure (ABP) ± raised central venous pressure (CVP). CVP was elevated in 9 patients (15.8%). The mediastinum was widened on chest radiograph in 4 occasions (10.5%). More than half of the patients (n=32, 56.1%) had arterial hemorrhage. The earliest re-exploration was required for arterial bleeding while bleeding of unknown origin was the latest to be re-explored. Decreased ABP and massive blood drainage were associated with early re-exploration, while radiological evidence of widened mediastinum and decreased Hb level were linked to late re-exploration.

Conclusion

A drop in ABP and massive blood drainage seem to be good predictors for exploration.

KEYWORDS

Cardiac surgery, Coronary artery bypass graft, Re-exploration.

References

1. Ranucci M, Baryshnikova E, Castelvecchio S, Pelissero G; Surgical and Clinical Outcome Research (SCORE) Group. Major bleeding, transfusions, and anemia: the deadly triad of cardiac surgery. Ann Thorac Surg 2013;96:478–85.

2. Marco Ranuccia, Ekaterina Baryshnikovaa, Valeria Pistuddia, L improvementorenzo Menicantib and Alessandro Frigiolab The effectiveness of 10 years of interventions to control postoperative bleeding in adult cardiac surgery. Interactive CardioVascular and Thoracic Surgery 2017;24:196–202.

3. Ranucci M, Bozzetti G, Ditta A, Cotza M, Carboni G, Ballotta A. Surgical re-exploration after cardiac operations: why a worse outcome? Ann Thorac Surg 2008;86:1557–62.

4. Haneya A, Diez C, Kolat P, Suesskind-Schwendi Mv, Ried M, Schmid C, Hirt SW. Re-exploration for bleeding or tamponade after cardiac surgery: impact of timing and indication on outcome. Thorac Cardiovasc Surg. 2015;63(1):51-7. doi: 10.1055/s-0034-1390154. Epub 2014 Sep 29

5. Biancari F, Mikkola R, Heikkinen J, Lahtinen J, Airaksinen KE, Juvonen T. Estimating the risk of complications related to re-exploration for bleeding after adult cardiac surgery: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2012;41:50–5.

6. Ranucci M, Baryshnikova E, Colella D. Monitoring pro-hemostatic treatment in bleeding patients. Semin Thromb Hemost 2012;38:282–91.

7. Ranucci M. Hemostatic and thrombotic issues in cardiac surgery. Semin Thromb Hemost 2015;41:84–90.

8. Gross I, Seifert B, Hofmann A, Spahn DR. Patient blood management in cardiac surgery results in fewer transfusions and better outcome. Transfusion 2015;55:1075–81.

9. Lopes CT, Brunori EH, Santos VB, Moorhead SA, Lopes Jde Lima, de Barros AL. Predictive factors for bleeding-related re-exploration after cardiac surgery: A prospective cohort study. Eur J Cardiovasc Nurs 2016; 15(3):e70–e77

10. Biancari F, Mikkola R, Heikkinen J, Lahtinen J, Kettunen U, Juvonen T. Individual Surgeon's Impact on the Risk of Re-exploration for Excessive Bleeding After Coronary Artery Bypass Surgery. Journal of Cardiothoracic and Vascular Anesthesia 2012;26( 4):550-556.

11.Hall TS, Brevetti GR, Skoultchi AJ, Sines JC, Gregory P, Spotnitz AJ. Re-exploration for hemorrhage following open heart surgery differentiation on the causes of bleeding and the impact on patient outcomes. Ann Thorac Cardiovasc Surg 2001;7(6):352-7.

12. Kristensen KL, Rauer LJ, Mortensen PE, Kjeldsen BJ. Reoperation for bleeding incardiac surgery. Interact Cardiovasc Thorac Surg 2012;14(6):709-13.

13. Grover A. Dhawan A, Iyengar SD, Anand IS, Wahi PL, Ganguly NK. Epidemiology of rheumatic fever and rheumatic heart disease in a rural community in northern India. Bulletin of the World Health Organization 1993;71(1): 59-66

14. Hall TS, Brevetti GR, Skoultchi AJ, Sines JC, Gregory P, Spotnitz AJ. Re-exploration for hemorrhage following open heart surgery differentiation on the causes of bleeding and the impact on patient outcomes. Ann Thorac Cardiovasc Surg 2001;7(6):352-7

15. Hitoshi Hirose& Akihito Takahashi, MD2Re-exploration for Bleeding after Coronary Artery Bypass Grafting. What is the Acceptable Range of Re-exploration Rate?; Ann Thorac Cardiovasc Surg Vol. 8, No. 4 (2002).

16.Miana LA, Atik FA, Moreira LF, Hueb AC, Jatene FB, Junior JO et al. Factors for postoperative bleeding after adult cardiac surgery. Braz J Cardiovasc Surg 2004; 19(3): 280-286.

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