RE-EXPLORATION AFTER OPEN HEART SURGERY AT THE MADRAS
MEDICAL MISSION, CHENNAI, INDIA
OKONTA KE*
RAJAN S
Department of Cardiac Surgery
Institute of Cardiovascular Diseases
Madras Medical Mission,
Chennai, India
Email:okontakelechi@yahoo.com
Email:drrajan1957@yahoo.com
Correspondence*
Grant support:
None
Conflict of Interest:
None
Abstract
Background: Re-explorations after open-heart surgery is a necessity in this
Cardiac Center when a patient is obviously bleeding or shows features of
cardiovascular instability. Timely intervention may reduce morbidity and
mortality
Objectives: This study aims to correlate the indications with the operative
findings for re-explorations after open-heart surgeries as a way of justifying
early surgical intervention.
Method: Between May2005 and April2011, 10,083 open-heart surgeries
were performed in the Adult Cardiac Surgical Unit of the department of
cardiac surgery, Institute of Cardiovascular Diseases, Madras Medical
Mission, Chennai, India. The demographic data, the initial diagnoses, the
types of surgery, the indications for re-exploration, the intraoperative
findings, the timing, the estimated blood loss and treatment for the 362
patients who had reexploration were analysed using the Predictive Analysis
Soft -ware(PASW)18.
Result: Out of the 10,083 patients who had cardiac operation within the
period of study, three hundred and sixty two (3.6%) patients had reexploration shortly after the operation. Males were 311(85.9%) while
51(14.1%) were female patients with mean age of 56.7+12.5years .The
mean time interval between the primary surgery and the re-exploratory
operation was 2.31+1.47hours and the mean chest tube drainage before reexploration was 770.9+28.8ml. Coronary Artery Diseases (CAD) was the
initial diagnosis 258 (71.3%) patients and Coronary Artery Bypass(CABG)
operation was the initial surgery in 254(70.2%)patients, CABG and valve in
12(3.3%)patients, Valve surgery alone in 70(19.3%) patients, Bentall
procedure(homograft aortic root replacement)in 13(3.6%) patients, others
such as off-pump coronary artery bypass, Dor procedure(patch restoration
of left ventricle by incising the aneurysm without excising it),
pericardiectomy and thromboembelectomy in 13(3.6%). The indications for
re-exploration were post operative haemorrhage in 283(78.2%) patients,
Cardiac tamponade in 41(11.3%)patients, reactionary haemorrhage and
cardiac tamponade in 12(3.3%)patients, clots In 20(5.5%) patients, open
sternum 5(1.4%) and forgotten foreign body in 1(0.3%)patients. The
intraoperative findings in 351(97.2%) patients revealed mediastinal clots
and bleeding points, while no active bleeding was seen at re-operation in
11(2.8%) patients. Pearsons Chi-square test between the indications for reexploration and the intraoperative findings was significant (p value<0.001).
Conclusion: There is strong evidence supporting early re-exploration in
patients after open-heart surgeries, complicated by reactionary
haemorrhage, cardiac tamponade and intra-thoracic clots; early reexploration reduced morbidity and mortality.
Key words:
Re-operation after open-heart surgery, Indications, Early re-exploration,
Good outcome, India