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Catastrophic hemorrhage on sternal reentry: still a dreaded complication?
F M Follis1, S B Pett, K B Miller
1Department of Cardiothoracic Surgery, University of New Mexico Health Sciences Center, Albuquerque 87131, USA. follis@unm.edu
The Annals of Thoracic Surgery
|January 5, 2000
Summary
Catastrophic hemorrhage (CH) risk during reoperations is significant, potentially reaching 1%. A sagittal micro oscillating saw demonstrated the lowest CH incidence, while conduits increased risk.
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.