Reopening for bleeding after adult cardiac surgery

Abstract EN

Objective : to determine the frequency and effects of post-operative bleeding among adult cardiac surgery patients at Queen Alia Heart Institute.

Methods: The medical records, operative and post-operative notes of 1000 adult patients who underwent open heart surgery (coronary artery bypass grafting, alular, ascending aorta and arch repair, and others) between January 2008 and April 2009 were retrospectively reviewed, 45 of them were reopened for bleeding.

Results : During the study period, 1000 patients underwent open heart surgery 45 (4.5 %) of them underwent reopening for bleeding ; 37 (82.2 %) were males and 8 (17.7 %) females.

The average age for those operated upon was 63 years, with an average Body Mass Index of 27.66.

The total pump run time was in the range of (54-220) minutes, with an average of 111.89 minutes.

25 (55.5 %) patients showed a surgical cause for bleeding, while 19 (42.2 %) showed a non-surgical cause.

All cases were reopened in the operating theatre except for 1 (2.22 %) who had to be reopened in the Intensive Care Unit.

The most common cause of surgical bleeding was conduit related, in the form of a slipped ligature or avulsed branch occurred in 6 (13.3 %) patients, followed by bleeding from the Left Internal Mammary Artery bed occurred in 5 (11.1 %) patients.

The most common non-surgical cause was related to preoperative medications, Aspirin and Plavix (Clopidogrel) being the most common (13.3 %), followed by Low Molecular weight Heparin (11.1 %).

The average ICU stay was 3.5 in comparison to 2 days for those not reopened, and the total hospital stay was in average 11.5 in comparison to 6 days for those not reopened.

Post reopening Atrial fibrillation happened in 8 (17.7) patients and sternal complications in 8 (17.7 %) and were the most common morbidities, followed by pleural and pericardial effusions, renal impairment, Intensive Care Unit delirium and psychosis, 2 (4.4 %) patients died.

Conclusion: Post-operative bleeding in cardiac surgery is a serious complication with an increase in both morbidity and mortality.

Thus extra care should be taken intraoperative to limit surgical causes of bleeding, in addition to encouraging policies that promote early return to the operating theatre for exploration once the criteria for reopening have been met.