REOPERATIONS FOR BLEEDING IN CARDIAC SURGERY: TREATMENT STRATEGY

Abstract             
 Introduction. Cardiac surgery patients are prone to bleeding postoperatively from the operative field, due to the presence of an extensive sternotomy wound, multiple vessels or heart suture lines, and disorders in hemostasis. In this study we retrospectively analyzed the outcomes of all patients who were reoperated for bleeding, within 5 years in our department.
Material and Methods.  A total of 4297 patients underwent heart surgery between February 2002 and January 2007, of which 98 (2.3%) were emergently reoperated for bleeding. We analyzed the process of indication for repeat surgery, possible source of bleeding, and postoperative complications.
 Results. Most (85.7%) of the reoperated patients had undergone their first operation as an elective cardiac procedure. The mean blood loss before the reoperation was 1557 ml. The studied group was characterized by increased mortality (11.2%), longer ventilation period (35.1 hours) and ICU (4.5 days) and hospital (13.3 days) stays. The postoperative outcomes did not differ significantly between patients with TEG-detected coagulation disorder and the rest of the patients, or between patients treated with antilysin and those who did not receive antifibrinolytics.