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[Factors associated to heavy bleeding during heart surgery with cardiopulmonary bypass]
Martha A Hernández-González1, Sergio Solorio, Carlos Luna-Quintero
1Unidad de Investigación en Epidemiología Clinica, UMAE 1, IMSS.
Insights
Heavy bleeding after cardiac surgery is linked to patient factors like obesity and functional class, and procedural elements such as longer surgery and cardiopulmonary bypass times. Managing these risk factors is crucial for patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Hematology
Context:
- Cardiac surgery frequently involves extracorporeal circulation, posing a risk of significant bleeding.
- Identifying pre-operative and intra-operative risk factors is essential for mitigating bleeding complications.
Purpose:
- To identify and evaluate risk factors associated with excessive bleeding in patients undergoing cardiac surgery with cardiopulmonary bypass.
- To analyze patient characteristics and surgical variables that predict hemorrhage.
Summary:
- A case-control study identified obesity, dyslipidemia, arterial hypertension, and advanced New York Heart Association (NYHA) functional class (III/IV) as significant risk factors for bleeding.
- Surgical factors including coronary artery bypass grafting, multivessel bypass, prolonged cardiopulmonary bypass time, aortic clamp time, and higher heparin doses were strongly associated with increased bleeding.
- Discriminant function analysis highlighted cardiopulmonary bypass duration, patient weight, aortic clamp time, and heparin dosage as key predictors of hemorrhage.
Impact:
- Findings can inform clinical practice by enabling better risk stratification and targeted interventions to reduce bleeding complications.
- Improved understanding of bleeding risk factors can lead to optimized patient management strategies and potentially reduce morbidity and mortality associated with cardiac surgery.
Objective:
To evaluate the risk factors related to bleeding in patients subjected to cardiac surgery using an extracorporeal circulation pump.
Material And Methods:
A study of cases and controls was designed performed in adults, matched by age and gender with indication of elective cardiac surgery using an extracorporeal circulation pump. Those patients with hepatic failure or blood coagulation disorders were excluded. Results were analyzed by Student t test, chi-square, and logistic regression analysis, considering p values significant at <0.05.
Results:
The patients with functional class III or IV of the CCS presented more bleeding (p = 0.006), although there were no differences when comparing the ejection fraction in both. Obesity, dyslipidemia, and arterial hypertension were identified as risk factors. The coronary artery bypass graft, multivessels bypass surgery, and prolonged surgical times are associated to the complication (p < 0.05). According to the discriminant function analysis, the cardiopulmonary derivation time, weight, aortic clamp time, and heparin doses are the factors that better discriminate the possibility of hemorrhage.
Conclusions:
Heavy bleeding is related to ischemic patients, longer cardiac surgery time, overweight, and heparin doses during surgery.
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