Open heart surgery: management of nonsurgical bleeding in the peri-operative period; 31/2-years institutional experience.

Abstract

BACKGROUND:Excessive perioperative bleeding remains a major complication following open heart surgery, resulting in increased morbidity and mortality of some patients in our institution.A study of the principal causes of excessive nonsurgical haemostatic perioperative bleeding,clinical evaluation,treatment and preventive strategies is justified.
OBJECTIVE/AIM: To identify the causes of bleeding in patients with haemorrhage that did not require reexploration and assess the impact on the patient outcomes from different causes of nonsurgical bleeding perioperatively.
MATERIALS AND METHOD: For a period of 31/2 years (March 2013 – February 2016), the National Cardiothoracic Center of Excellence,UNTH,Ituku/Ozalla,Enugu,Nigeria, partnered with different foreign cardiac missions (USA,UK and India) for the performance of open heart surgery.The case files of the patients managed in the envisaged period were retrieved and analyzed using SPSS, version 2.0(Chicago). The data analyzed were patients' demographics, the total number of open heart surgery cases, the number that had perioperative nonsurgical bleeding,clinical detection strategies,treatment and preventive modalities as well as the outcome.
RESULTS: During the period,a total number of 78 cases of open heart surgery (OHS) were done.There were 43 males and 35 females, with a ratio of approximately 1.3:1.The youngest age was 5 months and the oldest was 74 years, with a mean of 11.1 +/-SD 0.05. Out of these 78 cases, a total of 7 patients had perioperative nonsurgical bleeding, giving a percentage of 9%.3 patients were noticed intraoperatively in the operating room (OR) while 4 were noticed postoperatively in the intensive care unit (ICU). Treatment included the use of tranexemic acid or aprotinin, fresh frozen plasma (FFP) or fresh whole blood, platelet concentrate and additional doses of protamine, when incomplete reversal of heparin was the cause.
CONCLUSION: Detection of the cause(s) of nonsurgical bleeding without thromboelastography or platelet function analyzer can be quite challenging in our environment.Applying appropriate pharmacologic agents among other interventions can reduce allogenic blood requirements with their attendant complications.

KEY WORDS:Perioperative,Open heart surgery (OHS),thromboelastography,platelet function analyzer.