Catastrophic hemorrhage on sternal reentry: still a dreaded complication?

Area of Science:

• Cardiovascular Surgery
• Surgical Outcomes
• Hemorrhage Control

Background:

• Reoperation after cardiac surgery carries inherent risks.
• Catastrophic hemorrhage (CH) is a severe complication during reoperations.
• Defining the incidence of CH is crucial for improving patient safety.

Purpose of the Study:

• To determine the incidence of catastrophic hemorrhage (CH) during reoperations.
• To compare institutional experience with broader surgical practice regarding CH.
• To identify risk factors associated with CH during reoperations.

Main Methods:

• Review of 610 reoperations at the University of New Mexico, with 210 classified as high-risk.
• Questionnaire survey of surgeons regarding reentry techniques, CH occurrence, outcomes, and precautions.
• Statistical analysis to identify predictors of CH, including patient factors and surgical tools.

Main Results:

• The University of New Mexico reported a lower CH rate (0.65%) compared to the questionnaire data (2,046 CH).
• Specific sawing devices showed varying CH rates: reciprocating (2.09%), sagittal (2.0%), and Stryker (1.74%).
• A conduit was identified as a significant risk factor (p=0.005) for CH.

Conclusions:

• The overall risk of catastrophic hemorrhage during reoperations can be as high as 1%.
• The sagittal micro oscillating saw is associated with the lowest reported incidence of CH.
• The presence of a conduit significantly increases the risk of CH by 2.5-fold.