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Long-term Outcome of Reexploration for Bleeding After Coronary Artery Bypass Grafting

Jasmijn F Stroo1, Gijs J van Steenbergen1, Albert Hm van Straten1

  • 1Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands.

Journal of Cardiothoracic and Vascular Anesthesia
|June 23, 2023
PubMed

Insights

Reexploration for bleeding after coronary artery bypass grafting (CABG) increases short-term mortality but not long-term survival. Higher blood product use, not reexploration itself, is linked to poorer long-term outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Outcomes Research

Background:

  • Coronary artery bypass grafting (CABG) is a common cardiac procedure.
  • Reexploration for bleeding is a known complication following CABG.
  • The impact of reexploration on long-term mortality requires further investigation.

Purpose of the Study:

  • To determine the influence of reexploration for bleeding after CABG on long-term mortality.
  • To assess the association between blood product requirements and long-term survival post-CABG.

Main Methods:

  • Retrospective cohort study including patients who underwent CABG between 1998 and 2019.
  • Analysis of reexploration for bleeding and blood product transfusion as predictors of all-cause mortality.
  • Cox proportional hazards model used for statistical analysis with a median follow-up of 9.7 years.

Main Results:

  • 2.7% of patients (576/21,346) required reexploration for bleeding.
  • Reexploration was associated with significantly higher 30-day mortality (6.2% vs 1.6%).
  • Reexploration for bleeding was not significantly correlated with long-term mortality (HR 1.029, p=0.068).
  • Blood product transfusion, particularly packed red blood cells (pRBCs), was significantly associated with higher long-term mortality (HR=1.135, p<0.001).
  • After multivariate analysis, receiving ≥5 pRBCs was significantly associated with higher long-term mortality (HR 1.249, p<0.001).

Conclusions:

  • Reexploration for bleeding after CABG is linked to increased short-term mortality.
  • Long-term mortality is not significantly influenced by reexploration for bleeding itself.
  • Higher postoperative blood product transfusion requirements are a significant predictor of poorer long-term survival post-CABG.
Abstract

Keywords:
BleedingBlood transfusionCABGReexploration

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