Related Experiment Videos
Re-exploration after open heart surgery at the madras medical mission, chennai, India
1Department of Cardiac Surgery Institute of Cardiovascular Diseases Madras Medical Mission, Chennai, India.
Insights
Early re-exploration after open-heart surgery is crucial for patients experiencing bleeding or cardiovascular instability. This timely intervention significantly reduces complications and improves patient outcomes.
Area of Science:
- Cardiac Surgery
- Thoracic Surgery
- Cardiovascular Medicine
Background:
- Re-exploration after open-heart surgery is a necessary procedure for patients with bleeding or cardiovascular instability.
- Prompt intervention in such cases can decrease patient morbidity and mortality rates.
Purpose of the Study:
- To correlate the indications for re-exploration with operative findings after open-heart surgeries.
- To provide evidence supporting early surgical intervention in specific post-operative scenarios.
Main Methods:
- Analysis of data from 10,083 open-heart surgeries performed between May 2005 and April 2011.
- Review of demographic data, diagnoses, surgical types, re-exploration indications, intraoperative findings, and outcomes for 362 patients undergoing re-exploration.
Main Results:
- 3.6% of patients (362/10,083) required re-exploration, with post-operative hemorrhage being the most common indication (78.2%).
- Intraoperative findings confirmed mediastinal clots and bleeding points in 97.2% of re-explored patients.
- A significant correlation (p<0.001) was found between indications for re-exploration and intraoperative findings.
Conclusions:
- Strong evidence supports early re-exploration for open-heart surgery patients with reactionary hemorrhage, cardiac tamponade, or intra-thoracic clots.
- Early re-exploration is effective in reducing morbidity and mortality in these complex cases.
Background:
Re-explorations after open-heart surgery is a necessity in this Cardiac Center when a patient is obviously bleeding or shows features of cardiovascular instability. Timely intervention may reduce morbidity and mortality.
Objectives:
This study aims to correlate the indications with the operative findings for re-explorations after open-heart surgeries as a way of justifying early surgical intervention.
Method:
Between May2005 and April2011, 10,083 open-heart surgeries were performed in the Adult Cardiac Surgical Unit of the department of cardiac surgery, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India. The demographic data, the initial diagnoses, the types of surgery, the indications for re-exploration, the intraoperative findings, the timing, the estimated blood loss and treatment for the 362 patients who had reexploration were analysed using the Predictive Analysis Soft -ware(PASW)18.
Result:
Out of the 10,083 patients who had cardiac operation within the period of study, three hundred and sixty two (3.6%) patients had re-exploration shortly after the operation. Males were 311(85.9%) while 51(14.1%) were female patients with mean age of 56.7+12.5years .The mean time interval between the primary surgery and the re-exploratory operation was 2.31+1.47hours and the mean chest tube drainage before re-exploration was 770.9+28.8ml. Coronary Artery Diseases (CAD) was the initial diagnosis 258 (71.3%) patients and Coronary Artery Bypass(CABG) operation was the initial surgery in 254(70.2%)patients, CABG and valve in 12(3.3%)patients, Valve surgery alone in 70(19.3%) patients, Bentall procedure(homograft aortic root replacement)in 13(3.6%) patients, others such as off-pump coronary artery bypass, Dor procedure(patch restoration of left ventricle by incising the aneurysm without excising it), pericardiectomy and thromboembelectomy in 13(3.6%). The indications for re-exploration were post operative haemorrhage in 283(78.2%) patients, Cardiac tamponade in 41(11.3%)patients, reactionary haemorrhage and cardiac tamponade in 12(3.3%)patients, clots In 20(5.5%) patients, open sternum 5(1.4%) and forgotten foreign body in 1(0.3%)patients. The intraoperative findings in 351(97.2%) patients revealed mediastinal clots and bleeding points, while no active bleeding was seen at re-operation in 11(2.8%) patients. Pearsons Chi-square test between the indications for re-exploration and the intraoperative findings was significant (p value<0.001).
Conclusion:
There is strong evidence supporting early re-exploration in patients after open-heart surgeries, complicated by reactionary haemorrhage, cardiac tamponade and intra-thoracic clots; early re-exploration reduced morbidity and mortality.