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Ann Thorac Surg 1998;66:1472
© 1998 The Society of Thoracic Surgeons

Correspondence

Reoperation for cardiac postoperative bleeding

David B. Ross, MDa, Allan McIntyre, MDa, Carolyn MacDougall, RNa

a Division of Cardiovascular Surgery and Cardiac Anaesthesia, QEII Health Sciences Center, 1796 Summer St, Halifax, NS, Canada B3H 3A7

To the Editor

We read with interest the article by Pelletier and associates [1] describing a novel theory explaining why negative exploration for bleeding after a cardiac operation sometimes seems therapeutic. We also have noted this effect on occasion.

The reoperation rate for bleeding quoted in this article of 3% to 5% (7% for redo cases) seems high, at least in our experience. From March 1995 to March 1998, we performed 3,213 open cardiac operations of all types including routine cases as well as emergency thoracic aortic operations. As we are the only cardiac center for our region, this represents an unselected population. All patients received an antifibrinolytic agent, almost always {varepsilon}-aminocaproic acid (150 mg/kg loading dose and 15 mg · kg-1 h-1 infusion for the duration of the operation). A few patients received aprotinin.

Forty-one patients underwent reoperation for bleeding (1.27%; 95% confidence interval, 0.89% to 1.66%). In the 373 patients (11.6%) who had had one or more previous cardiac operations the reoperation rate for bleeding was 2.41% (95% confidence interval, 0.86% to 3.97%). An aggressive approach to reoperation for bleeding was employed, and overall only 29.6% of all patients required transfusion of blood products. For those having had one or more previous cardiac operations the transfusion rate was 46%.

With meticulous surgical technique and the routine use of antifibrinolytic agents the problem of postoperative bleeding can be reduced to a fraction of its former rate with obvious benefits for both the patients and the surgical staff.

References

  1. Pelletier M.P., Solymoss S., Lee A., Chiu R.C.-J. Negative reexploration for cardiac postoperative bleeding: can it be therapeutic?. Ann Thorac Surg 1998;65:999-1002.[Abstract/Free Full Text]




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