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Reoperations for bleeding after coronary artery bypass procedures during 25 years
M Sellman1, M A Intonti, T Ivert
1Thoracic Surgical Clinic, Karolinska Hospital, Stockholm, Sweden.
Insights
Reoperation for bleeding after coronary artery bypass surgery occurred in 4.4% of patients, with the internal mammary artery being a common cause. Elderly patients and those undergoing combined procedures faced higher risks.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Research
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for treating coronary artery disease.
- Reoperation for bleeding is a significant complication following CABG, impacting patient outcomes and healthcare costs.
Purpose of the Study:
- To investigate the incidence, causes, and risk factors associated with reoperation for bleeding after coronary artery bypass procedures.
- To analyze trends in reoperation rates and identify specific patient and surgical factors contributing to this complication.
Main Methods:
- Retrospective review of 8563 coronary artery bypass procedures performed between 1970 and 1994.
- Analysis of patient demographics, surgical techniques, causes of bleeding, and reoperation rates.
- Logistic regression analysis to identify independent risk factors for reoperation.
Main Results:
- The overall incidence of reoperation for bleeding was 4.4%, with a decrease to 3.2% by 1994.
- The internal mammary artery or its graft site was the primary source of bleeding in 43% of cases.
- Risk factors for reoperation included older age (≥80 years), combined coronary artery bypass and intracardiac repair procedures, and earlier surgical years (1970-1989).
Conclusions:
- While reoperation for bleeding is a serious complication, its incidence has shown a declining trend.
- Specific patient populations, particularly the elderly and those undergoing complex combined procedures, require heightened vigilance and tailored precautions to minimize bleeding risks.
- The internal mammary artery, while beneficial for long-term graft patency, necessitates careful management to mitigate bleeding complications.
Objectives And Methods:
To study the incidence, causes and risk factors of reoperation for bleeding, 8563 coronary artery bypass procedures performed during 1970-1994 were reviewed.
Results:
Patients operated on during 1990-1994 were older, the internal mammary artery was used more frequently, more grafts were inserted, more combined and redo bypass procedures were performed than during 1970-1989. There were 402 early resternotomies but in 24 patients (6%) no bleeding was encountered and the compromised haemodynamics was caused by left ventricular failure. Postoperative bleeding caused reoperation in 378 patients (4.4%). There were 3.2% reoperations in 1994. The internal mammary artery or its bed was the main cause of the bleeding in 43%. The reoperations were performed earlier and emergent reoperations because of cardiac tamponade were less common during 1990-1994 than during 1970-1989. Reoperation for bleeding was required in 8.6% of patients 80 years of age and older. Combined coronary bypass surgery and intracardiac repair implied a 1.7 higher risk of reoperation for bleeding compared with patients undergoing primary isolated bypass surgery. Logistic regression analysis predicted old age, combined procedure, early year of surgery and use of the internal mammary artery as risk factors of reoperation for bleeding. The risk of reoperation was not significantly related to number of grafts inserted or if the patient had undergone previous cardiac surgery. Reoperation for bleeding increased the stay in intensive care by at least one day but did not increase the risk of wound infection.
Conclusions:
Special precautions seem indicated to reduce the risk of reoperation for bleeding in particularly elderly patients undergoing combined coronary surgery and other intracardiac repair.