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Evaluation of Causes of Reexploration for Bleeding or Hemodynamic Instability in Immediate Postoperative Period in Cardiac Surgery ICU

Subhendu Sekhar Mahapatra , Jayita Chakrabarti , Subhendu Sekhar Mahapatra ,

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Journal of Cardiovascular Medicine and Surgery 6(1):p 63-67, January-March 2020. | DOI: http://dx.doi.org/10.21088/jcms.2454.7123.6120.11

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Jayita Chakrabarti, Subhendu Sekhar Mahapatra. Evaluation of Causes of Reexploration for Bleeding or hemodynamic instability in immediate postoperative period in Cardiac Surgery ICU. J Cardiovasc Med Surg. 2020;6(1):63-67.

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Received : N/A         Accepted : N/A          Published : N/A

Abstract

Introduction: Throughout the world, up to five percent of postoperative cardiac surgery patients undergo reexploration. In our institution the reexploration rate is quite high and we hypothesise, being a training institute it is such. The aim of our study is to find the causes of reexploration so we can modify our operative approach. Materials and Methods: 2792 non randomised post operative patients were studied prospectively and was done from October 2010 to March 2016. Patients who underwent reexplorations following coronary artery bypass surgery both offpump or onpump, valvular heart surgery, surgery for congenital acyanotic heart disease, cardiac myxomas were included in the study. Cyanotic heart disease, redo surgery, aortic surgery or other complex surgery cases were excluded. 287 patients were reexplored for excessive bleeding or cardiac tamponade and arrhythmia in post operative cardiac surgery ICU. Statistical Analysis: All normally distributed numerical variables were analysed by Kolmogorov-Smirnov test. Categorical variables were compared by Binomial test. p - value less than or equal to 0.05 was considered significant. Results: Maximum reexploration was done in CABG with valve cases (33%). 252 patients (87.8%) were reexplored for bleeding and the rest (12.2%) for tamponade. 219 patients (87%) were found to have surgical causes of bleeding, and the rest (13%) had diffuse, non-surgical type of bleeding. The sternal wire site bleeding and bleeding from left internal mammary artery bed were in very high percentage. Conclusions: Reexploration for bleeding is a great concern especially in a high volume training centre like ours. Meticulous and careful surgical approach and a responsible hemostasis and closure may cut down the reexploration rate significantly.

 

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Cite this article

Jayita Chakrabarti, Subhendu Sekhar Mahapatra. Evaluation of Causes of Reexploration for Bleeding or hemodynamic instability in immediate postoperative period in Cardiac Surgery ICU. J Cardiovasc Med Surg. 2020;6(1):63-67.

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DOI: http://dx.doi.org/10.21088/jcms.2454.7123.6120.11

Keywords

Bleeding; Reexploration; Training Institute.

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