Re-operations for bleeding in cardiac surgery: treatment strategy

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Critical Care Medicine

Background:

• Postoperative bleeding is a significant complication following cardiac surgery.
• Patients undergoing cardiac surgery face risks from sternotomy, sutures, and hemostasis disorders.

Purpose of the Study:

• To retrospectively analyze outcomes of patients re-operated for bleeding after cardiac surgery.
• To identify factors influencing outcomes and complications in reoperated patients.

Main Methods:

• Retrospective analysis of 4297 cardiac surgery patients from February 2002 to January 2007.
• Identified 98 patients (2.3%) requiring emergency reoperation for bleeding.
• Analyzed indication for reoperation, bleeding sources, and postoperative complications.

Main Results:

• Most reoperated patients (85.7%) had prior elective cardiac procedures.
• Mean blood loss before reoperation was 1557 ml.
• Reoperated patients experienced increased mortality (11.2%), prolonged ventilation (35.1 hours), and extended ICU (4.5 days) and hospital (13.3 days) stays.

Conclusions:

• Minimizing delay in reoperation indication is vital for patient outcomes.
• Echocardiography and Thromboelastography (TEG) can expedite diagnosis and reduce delays.
• Consider increased platelet administration and reserve antifibrinolytics for confirmed fibrinolysis.