PREDICTORS OF RE-EXPLORATION FOR BLEEDING AFTER CORONARY ARTERY BYPASS GRAFT
AND VALVE SURGERY

Amanj K Mohammad a


a Unit of Thoracic and Cardiovascular Surgery,Department of Surgery, College of Medicine, University of Sulaimani. 


Submitted: 14/1/2018; Accepted: 8/7/2018; Published 15/10/2018

ABSTRACT


Background 

A significant number of patients undergoing cardiac surgery require re-exploration for postoperative bleeding. 


Objectives 

The aim of this study is to find out the predictors of re-exploration for such bleeding.


Patients and Methods

Over a 5-year period (January 2010-December 2014) 1,565 patients underwent open-heart surgery in Slemani Cardiac Hospital, Sulaimaniyah, Iraq. Fifty seven patients (3.6%) were identified as having a significant bleeding after coronary artery bypass graft (CABG) and/or valve operations requiring urgent exploration within few hours. The medical records of these patients were retrospectively reviewed. 


Results

There were 36 males and 21 females. The mean age was 61.8±7.5 years. The majority of patients had CABG (n=41, 71.9%) while the remainder 16 patients (28.1%) had valve operations. The mean time interval between the primary cardiac operation and re-exploration was 3.17 ± 1.5 hours. Twenty nine patients (50.9%) had a drop in hemoglobin level. Thirteen patients (22.8%) had a fall in arterial blood pressure (ABP) ± raised central venous pressure (CVP). CVP was elevated in 9 patients (15.8%). The mediastinum was widened on chest radiograph in 4 occasions (10.5%). More than half of the patients (n=32, 56.1%) had arterial hemorrhage. The earliest re-exploration was required for arterial bleeding while bleeding of unknown origin was the latest to be re-explored. Decreased ABP and massive blood drainage were associated with early re-exploration, while radiological evidence of widened mediastinum and decreased Hb level were linked to late re-exploration. 


Conclusion

A drop in ABP and massive blood drainage seem to be good predictors for exploration.


KEYWORDS

Cardiac surgery, Coronary artery bypass graft, Re-exploration.