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Canadian Journal of Anesthesia 49:A81 (2002)
© Canadian Anesthesiologists' Society, 2002

Abstracts - Tuesday June 25th 2002 1030 - 1230

PREDICTORS FOR CHEST REEXPLORATION TO CONTROL BLEEDING IN CARDIAC SURGERY

George N. Djaiani, MD, Jayanta Muhkerji, MD, Jacek M. Karski, MD and Jo A. Carroll, RN

Department of Anesthesia, Toronto General Hospital, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4

INTRODUCTION

Rate of reoperation to control excessive bleeding after cardiac surgery is 5%. The predictors for reoperation are not well defined.

METHODS

After IRB approval, we collected prospective data on 2013 patients undergoing cardiac surgery. On the basis of reoperation owing to excessive bleeding, patients were divided into two groups; reoperated and non-reoperated. All received tranexamic acid 50-100 mg.kg-1 before sternotomy. Time to reoperation, rate of bleeding, total blood loss and blood transfusion within 24h after surgery was recorded.

RESULTS

We identified 93 (4.6%) patients with 6h postoperative blood loss >= 750 ml. Complete data was obtained on 84 patients. 48 (57%) required reexploration to control bleeding, within 276 ± 206 min of arrival to ICU. Mean blood loss in this group was 1238 ± 623 ml. The rate of bleeding was 371 ± 271 ml.h-1. There was no difference with preoperative hemoglobin, diabetes, previous cardiac surgery, aspirin, heparin, coumadin, CPB time, and postoperative coagulation measurements between the groups. Significant differences between groups presented in TableGo.


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Aortic valve patients were more likely to require reoperation (37% vs 11% in reoperated and non-reoperated groups respectively, p=0.006). 47 (98%) patients in the reoperated and 26 (72%) in the non-reoperated received blood transfusions (p=0.001). During reoperation, 28 (58%) patients had surgical source of bleeding. Bleeding sites; left internal thoracic artery 9 (32%) patients, chest wall 8 (29%) patients, aorta 5 (18%) patients, atrium 4 (14%) patients, and 2 other sites.

DISCUSSION

The rate of bleeding per hour is a significant predictor of chest reexploration after cardiac surgery. Patients who require reoperation are at higher risk for blood transfusion and longer ICU and hospital LOS.





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