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Open Access 01-12-2021 | Heart Surgery | Research article

Re-exploration for bleeding after cardiac surgery: revaluation of urgency and factors promoting low rate

Authors: Ahmed Abdelrahman Elassal, Khalid Ebrahim Al-Ebrahim, Ragab Shehata Debis, Ehab Sobhy Ragab, Mazen Shamsaldeen Faden, Mazin Adel Fatani, Amr Ragab Allam, Ahmed Hasan Abdulla, Auhood Mohammednoor Bukhary, Nada Ahmed Noaman, Osama Saber Eldib

Published in: Journal of Cardiothoracic Surgery | Issue 1/2021

Abstract

Background

Re-exploration of bleeding after cardiac surgery is associated with significant morbidity and mortality. Perioperative blood loss and rate of re-exploration are variable among centers and surgeons.

Objective

To present our experience of low rate of re-exploration based on adopting checklist for hemostasis and algorithm for management.

Methods

Retrospective analysis of medical records was conducted for 565 adult patients who underwent surgical treatment of congenital and acquired heart disease and were complicated by postoperative bleeding from Feb 2006 to May 2019. Demographics of patients, operative characteristics, perioperative risk factors, blood loss, requirements of blood transfusion, morbidity and mortality were recorded. Logistic regression was used to identify predictors of re-exploration and determinants of adverse outcome.

Results

Thirteen patients (1.14%) were reexplored for bleeding. An identifiable source of bleeding was found in 11 (84.6%) patients. Risk factors for re-exploration were high body mass index, high Euro SCORE, operative priority (urgent/emergent), elevated serum creatinine and low platelets count. Re-exploration was significantly associated with increased requirements of blood transfusion, adverse effects on cardiorespiratory state (low ejection fraction, increased s. lactate, and prolonged period of mechanical ventilation), longer intensive care unit stay, hospital stay, increased incidence of SWI, and higher mortality (15.4% versus 2.53% for non-reexplored patients). We managed 285 patients with severe or massive bleeding conservatively by hemostatic agents according to our protocol with no added risk of morbidity or mortality.

Conclusion

Low rate of re-exploration for bleeding can be achieved by strict preoperative preparation, intraoperative checklist for hemostasis implemented by senior surgeons and adopting an algorithm for management.

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Title: Re-exploration for bleeding after cardiac surgery: revaluation of urgency and factors promoting low rate
Authors: Ahmed Abdelrahman Elassal
Khalid Ebrahim Al-Ebrahim
Ragab Shehata Debis
Ehab Sobhy Ragab
Mazen Shamsaldeen Faden
Mazin Adel Fatani
Amr Ragab Allam
Ahmed Hasan Abdulla
Auhood Mohammednoor Bukhary
Nada Ahmed Noaman
Osama Saber Eldib
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Heart Surgery
Heart Surgery
Published in: Journal of Cardiothoracic Surgery / Issue 1/2021
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-021-01545-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Re-exploration for bleeding after cardiac surgery: revaluation of urgency and factors promoting low rate

Abstract

Background

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusion

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