Excessive bleeding and reexploration after cardiac surgery is a simple and worth thinking about issue_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 QIAN Yongjun , YU Hui , LIANG Weitao , LI Tao , XIAO Xijun

Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

QIAN Yongjun, Email: yongjunqian@sina.com

Keywords：

Excessive bleeding; reexploration; cardiac surgery

DOI：

10.7507/1007-4848.201711036

Video：

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The incidence of postoperative excessive bleeding and reexploration is relatively high, and it will bring a series of serious complications, such as an additional surgery, a longer intensive care unit stay, longer time on mechanical ventilation, an increase need of allogeneic blood product transfusions and increased mortality. However, the understanding of postoperative excessive bleeding and reexploration in China is significantly different from the international level, and the understanding of postoperative excessive bleeding and reexploration after cardiac surgery in clinical work is still not enough. This review will focus on some problems, such as related factors analysis of postoperative excessive bleeding, hemostatic process optimization and the serious complications of reexploration after cardiac surgery.

Citation： QIAN Yongjun, YU Hui, LIANG Weitao, LI Tao, XIAO Xijun. Excessive bleeding and reexploration after cardiac surgery is a simple and worth thinking about issue. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(5): 368-371. doi: 10.7507/1007-4848.201711036 Copy

1.	Mehta RH, Sheng S, O’Brien SM, et al. Reoperation for bleeding in patients undergoing coronary artery bypass surgery: incidence, risk factors, time trends, and outcomes. Circ Cardiovasc Qual Outcomes, 2009, 2(6): 583-590.
2.	Choong CK, Gerrard C, Goldsmith KA, et al. Delayed re-exploration for bleeding after coronary artery bypass surgery results in adverse outcomes. Eur J Cardiothorac Surg, 2007, 31(5): 834-838.
3.	Christensen MC, Dziewior F, Kempel A, et al. Increased chest tube drainage is independently associated with adverse outcome after cardiac surgery. J Cardiothorac Vasc Anesth, 2012, 26(1): 46-51.
4.	Lopes CT, Dos Santos TR, Brunori EH, et al. Excessive bleeding predictors after cardiac surgery in adults: integrative review. J Clin Nurs, 2015, 24(21-22): 3046-3062.
5.	Roeloffzen WW, Kluin-Nelemans HC, Mulder AB, et al. In normal controls, both age and gender affect coagulability as measured by thrombelastography. Anesth Analg, 2010, 110(4): 987-994.
6.	Dixon B, Reid D, Collins M, et al. The operating surgeon is an independent predictor of chest tube drainage following cardiac surgery. J Cardiothorac Vasc Anesth, 2014, 28(2): 242-246.
7.	Miceli A, Duggan SM, Aresu G, et al. Combined clopidogrel and aspirin treatment up to surgery increases the risk of postoperative myocardial infarction, blood loss and reoperation for bleeding in patients undergoing coronary artery bypass grafting. Eur J Cardiothorac Surg, 2013, 43(4): 722-728.
8.	Bosch Y, Al Dieri R, ten Cate H, et al. Preoperative thrombin generation is predictive for the risk of blood loss after cardiac surgery: a research article. J Cardiothorac Surg, 2013, 8: 154.
9.	Emeklibas N, Kammerer I, Bach J, et al. Preoperative hemostasis and its association with bleeding and blood component transfusion requirements in cardiopulmonary bypass surgery. Transfusion, 2013, 53(6): 1226-1234.
10.	Thiele RH, Raphael J. A 2014 update on coagulation management for cardiopulmonary bypass. Semin Cardiothorac Vasc Anesth, 2014, 18(2): 177-189.
11.	Achneck HE, Sileshi B, Parikh A, et al. Pathophysiology of bleeding and clotting in the cardiac surgery patient: from vascular endothelium to circulatory assist device surface. Circulation, 2010, 122(20): 2068-2077.
12.	Bodnarescu S, Acharya M, Mohiyaddin S, et al. EuroSCORE: a marker for resternotomy for bleeding post cardiac surgery? International J Surgery, 2015, 23: S33-S34.
13.	Moulton MJ, Creswell LL, Mackey ME, et al. Reexploration for bleeding is a risk factor for adverse outcomes after cardiac operations. J Thorac Cardiovasc Surg, 1996, 111(5): 1037-1046.
14.	Kouchoukos NT, Blackstone EH, Hanley F, et al. Kirklin/Barratt-Boyes Cardiac Surgery: Morphology, Diagnostic Criteria, Natural History, Techniques, Results, and Indications. 4th ed. Amsterdam: Elsevier, 2013. 220-223.
15.	Dixon B, Santamaria JD, Reid D, et al. The association of blood transfusion with mortality after cardiac surgery: cause or confounding? (CME). Transfusion, 2013, 53(1): 19-27.
16.	Dial S, Delabays E, Albert M, et al. Hemodilution and surgical hemostasis contribute significantly to transfusion requirements in patients undergoing coronary artery bypass. J Thorac Cardiovasc Surg, 2005, 130: 654-661.
17.	Biancari F, Mikkola R, Heikkinen J, et al. Individual surgeon’s impact on the risk of re-exploration for excessive bleeding after coronary artery bypass surgery. J Cardiothorac Vasc Anesth, 2012, 26(4): 550-556.
18.	Loor G, Vivacqua A, Sabik JF 3rd, et al. Process improvement in cardiac surgery: development and implementation of a reoperation for bleeding checklist. J Thorac Cardiovasc Surg, 2013, 146(5): 1028-1032.
19.	Hales BM, Pronovost PJ. The checklist--a tool for error management and performance improvement. J Crit Care, 2006, 21(3): 231-235.

1. Mehta RH, Sheng S, O’Brien SM, et al. Reoperation for bleeding in patients undergoing coronary artery bypass surgery: incidence, risk factors, time trends, and outcomes. Circ Cardiovasc Qual Outcomes, 2009, 2(6): 583-590.
2. Choong CK, Gerrard C, Goldsmith KA, et al. Delayed re-exploration for bleeding after coronary artery bypass surgery results in adverse outcomes. Eur J Cardiothorac Surg, 2007, 31(5): 834-838.
3. Christensen MC, Dziewior F, Kempel A, et al. Increased chest tube drainage is independently associated with adverse outcome after cardiac surgery. J Cardiothorac Vasc Anesth, 2012, 26(1): 46-51.
4. Lopes CT, Dos Santos TR, Brunori EH, et al. Excessive bleeding predictors after cardiac surgery in adults: integrative review. J Clin Nurs, 2015, 24(21-22): 3046-3062.
5. Roeloffzen WW, Kluin-Nelemans HC, Mulder AB, et al. In normal controls, both age and gender affect coagulability as measured by thrombelastography. Anesth Analg, 2010, 110(4): 987-994.
6. Dixon B, Reid D, Collins M, et al. The operating surgeon is an independent predictor of chest tube drainage following cardiac surgery. J Cardiothorac Vasc Anesth, 2014, 28(2): 242-246.
7. Miceli A, Duggan SM, Aresu G, et al. Combined clopidogrel and aspirin treatment up to surgery increases the risk of postoperative myocardial infarction, blood loss and reoperation for bleeding in patients undergoing coronary artery bypass grafting. Eur J Cardiothorac Surg, 2013, 43(4): 722-728.
8. Bosch Y, Al Dieri R, ten Cate H, et al. Preoperative thrombin generation is predictive for the risk of blood loss after cardiac surgery: a research article. J Cardiothorac Surg, 2013, 8: 154.
9. Emeklibas N, Kammerer I, Bach J, et al. Preoperative hemostasis and its association with bleeding and blood component transfusion requirements in cardiopulmonary bypass surgery. Transfusion, 2013, 53(6): 1226-1234.
10. Thiele RH, Raphael J. A 2014 update on coagulation management for cardiopulmonary bypass. Semin Cardiothorac Vasc Anesth, 2014, 18(2): 177-189.
11. Achneck HE, Sileshi B, Parikh A, et al. Pathophysiology of bleeding and clotting in the cardiac surgery patient: from vascular endothelium to circulatory assist device surface. Circulation, 2010, 122(20): 2068-2077.
12. Bodnarescu S, Acharya M, Mohiyaddin S, et al. EuroSCORE: a marker for resternotomy for bleeding post cardiac surgery? International J Surgery, 2015, 23: S33-S34.
13. Moulton MJ, Creswell LL, Mackey ME, et al. Reexploration for bleeding is a risk factor for adverse outcomes after cardiac operations. J Thorac Cardiovasc Surg, 1996, 111(5): 1037-1046.
14. Kouchoukos NT, Blackstone EH, Hanley F, et al. Kirklin/Barratt-Boyes Cardiac Surgery: Morphology, Diagnostic Criteria, Natural History, Techniques, Results, and Indications. 4th ed. Amsterdam: Elsevier, 2013. 220-223.
15. Dixon B, Santamaria JD, Reid D, et al. The association of blood transfusion with mortality after cardiac surgery: cause or confounding? (CME). Transfusion, 2013, 53(1): 19-27.
16. Dial S, Delabays E, Albert M, et al. Hemodilution and surgical hemostasis contribute significantly to transfusion requirements in patients undergoing coronary artery bypass. J Thorac Cardiovasc Surg, 2005, 130: 654-661.
17. Biancari F, Mikkola R, Heikkinen J, et al. Individual surgeon’s impact on the risk of re-exploration for excessive bleeding after coronary artery bypass surgery. J Cardiothorac Vasc Anesth, 2012, 26(4): 550-556.
18. Loor G, Vivacqua A, Sabik JF 3rd, et al. Process improvement in cardiac surgery: development and implementation of a reoperation for bleeding checklist. J Thorac Cardiovasc Surg, 2013, 146(5): 1028-1032.
19. Hales BM, Pronovost PJ. The checklist--a tool for error management and performance improvement. J Crit Care, 2006, 21(3): 231-235.

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