Open Heart Surgery: Management of Nonsurgical Bleeding in the Peri-Operative Period; 31/2-Years Institutional Experienc

Abstract

Background: Excessive perioperative bleeding remains a major complication following open heart surgery, resulting in increased morbidity and mortality of some patients in our institution. A study of the principal causes of excessive nonsurgical haemostatic perioperative bleeding, clinical evaluation, treatment and preventive strategies is justifi ed.Objective/Aim: To characterize the causes of bleeding in patients with hemorrhage that did not require re-exploration and assess the impact on the patient outcomes from different causes of nonsurgical bleeding preoperatively. Materials and Methods:For a period of 3 1/2 years (March 2013 -February 2016, the National Cardiothoracic Center of Excellence, UNTH, Ituku/Ozalla, Enugu, Nigeria, partnered with different foreign cardiac missions (USA, UK and India) for the performance of open heart surgery. The case fi les of the patients managed in the envisaged period were retrieved and analyzed using SPSS, version 4.0. The data analyzed were patients' demographics, the total number of open heart surgery cases, the number that had perioperative nonsurgical bleeding, clinical detection strategies, treatment and preventive modalities as well as the outcome.Results: During the period, a total number of 78 cases of open heart surgery (OHS) were done. There were 43 males and 35 females, with a ratio of approximately 4:3. The youngest age was 5 months and the oldest was 74 years, with a mean of 1.0. Out of these 78 cases, a total of 7 patients had perioperative nonsurgical bleeding, giving a percentage of 9%. 3 patients were noticed intraoperatively in the operating room (OR) while 4 were noticed postoperatively in the intensive care unit (ICU). Treatment included preoperative preventive strategies, the use of tranexemic acid or aprotinin, fresh frozen plasma (FFP) or fresh whole blood, platelet concentrate and additional doses of protamine, when incomplete reversal of heparin was the cause. Conclusion:Detection of the cause(s) of nonsurgical bleeding without Thromboelastography or platelet function analyzer can be quite challenging in our environment. Applying appropriate pharmacologic agents among other interventions can reduce allogenic blood requirements with their attendant complications. Research ArticleOpen Heart Surgery: Management

Surgical management of CHD in the adult population: the role of humanitarian cardiac surgery mission in Nigeria

“…9 Other postoperative challenges are hyper-viscosity syndrome due to chronic erythrocytosis and disseminated intravascular coagulopathy. 10 The causes of the disseminated intravascular coagulopathy are friable collateral vessels, extensive suture lines, prolonged cardiopulmonary bypass time, and the engendered thrombocytopathy and thrombocytopaenia, as well as hyperfibroginaemia. 10 Materials and method Over a 5.5-year period -June 2003, February, 2013-October, 2017five different humanitarian cardiac surgery teams visited National Cardiothoracic Center of Excellence, Enugu, Nigeria, and performed surgical interventions on some adults with CHDs.…”

“…Cyanosis in adults with CHDs undergoing heart surgery is an independent predictor of early morbidity and mortality owing to the combined effects of chronic cyanosis on haemostasis, and renal and ventricular function 9 . Other postoperative challenges are hyper-viscosity syndrome due to chronic erythrocytosis and disseminated intravascular coagulopathy 10 . The causes of the disseminated intravascular coagulopathy are friable collateral vessels, extensive suture lines, prolonged cardiopulmonary bypass time, and the engendered thrombocytopathy and thrombocytopaenia, as well as hyperfibroginaemia 10 …”

Utilisation of blood and blood products during open heart surgery in a low-income country: our local experience in 3 years

“…, 24 Postoperatively, inadequate reversal of heparin, degree of hypothermia, thrombocytopaenia, and reduced clotting factors played significant roles in our study, as in other studies 25 . This is because thromboelastography and platelet function analyser are not available in our centre for point of care diagnostic tests 26 …”

“…25 This is because thromboelastography and platelet function analyser are not available in our centre for point of care diagnostic tests. 26 Blood haemoglobin level is the current trigger used for packed red blood cell transfusion, although commonly admitted to be suboptimal. An increase in haemoglobin level is likely to be associated with an increase in blood oxygen content and blood oxygen delivery.…”