Re-exploration for bleeding or tamponade after cardiac operation

Abstract

The aim of this study was to determine the outcome of patients who had a chest resternotomy and to identify risk factors for higher in-hospital mortality after re-exploration for bleeding and/or tamponade after cardiac operations. We present our experience of an acceptably low re-exploration rate after cardiac surgery, and the outcomes of those re-explored. This was a retrospective analysis of medical records of all patients who had a chest re-exploration for the control of bleeding and cardiac tamponade over a 7-year period (2000-06), at the Cardiothoracic Centre of the Hospital České Budějovice, Czech Republic. Between 2000 and 2006, 152 patients (3.4% of the total heart operations) underwent re-exploration after heart surgery. One hundred and seven (70.4%) were re-explored for bleeding, 36 (23.7%) for possible tamponade and nine (5.9%) for both. An identifiable source of bleeding was found in 72.4% patients. Risk factors associated with higher in-hospital mortality after re-exploration for bleeding and tamponade include delayed resternotomy, higher levels of lactate and lower levels of haematocrit before revision and other well-known risk factors such as older age, more complex cardiac procedures, redo operations, longer cardiopulmonary bypass, renal failure and diabetes mellitus. Patients who need re-exploration are at a higher risk of complications, morbidity and mortality if the time until re-exploration is prolonged.

Feasibility of diagnosis of postcardiotomy tamponade by miniaturized transesophageal echocardiography

“…Untreated pericardial collection after cardiac surgery may quickly progress to unstable hemodynamics, cardiogenic shock and subsequent death. 5 The incidence of the pericardial tamponade varies from 0.2% after coronary artery bypass grafting to 8.4% after heart transplants. 6 The concern of developing post-surgical pericardial tamponade has been increasing in patients especially those on a new generation of antiplatelet agents and/or anticoagulants.…”

“…Any delay in reexploration can lead into fatal and non-fatal complications. 1,2 However, the diagnosis of pericardial tamponade is not always easy and sometimes requires additional imaging studies.…”

Outcome measures and quality markers for perioperative blood loss and transfusion in cardiac surgery

“…Additionally, a surgical revision is often required to control bleeding (or its sequelae-i.e., tamponade) in a variable percentage (2-7%) of patients. [2][3][4] Both perioperative bleeding and transfusions have been considered determinants of adverse outcomes, [5][6][7][8] and surgical reoperation to address bleeding is associated with an increased rate of perioperative mortality. 2,4 Therefore, bleeding and/or transfusions have been considered as specific outcome measures in many different studies.…”

Perioperacinių veiksnių įtaka sekrecijai per drenus po aortovainikinio nuosrūvio suformavimo operacijų

“…Kraujavimas širdies chirurgijoje išlieka dideliu iššūkiu ir dažnai būna vienas pagrindinių veiksnių, lemiančių baigtis. [5] Pooperacinis kraujavimas po širdies operacijų, literatūros duomenimis, yra susijęs su blogesnėmis pooperacinėmis baigtimis [6,7]. Nustatyta daug rizikos veiksnių, sąlygojančių perioperacinį kraujo netekimą: amžius, mažas kūno paviršiaus plotas, kombinuotos operacijos (AVJSO ir vožtuvų chirurgija), šuntų skaičius (≥ 5), priešoperacinis antiagregantų vartojimas, pailgėjusi DKA trukmė (>150 min.…”

“…Medicininėje literatūroje gausu priešta-ringo pobūdžio duomenų dėl aspirino (A) vartojimo širdies chirurgijoje [7,[9][10][11][12][13]. J. Canadyova ir kolegos, retrospektyviai ištyrę 2824 pacientus, kuriems atliktos aortovainikinio nuosrūvio suformavimo operacijos, teigia, kad antiagregantų vartojimas iki operacijos (tarp jų ir A) nėra susijęs su resternotomija dėl kraujavimo bei padidėjusio mirštamumo rizika [7].…”