Early chest re-exploration after adult cardiac surgery

Abstract

Background: Aim of the study was to determine the rate, causes, consequences of early re-sternotomy after cardiac surgery and to compare between re-opening in the operative theatre and re-opening in the intensive care unit (ICU). Methods: This is an observational retrospective study of adult cardiac surgical patients presenting for cardiac surgery at Queen Alia heart institute in the between September 2023 and February 2024. Incidence, risk factors, causes, site and consequences of early re-sternotomy are studied. Results: Data from 182 patients was analysed. Male patients were 82.4% and female patients were 17.6%. Reopening was needed in 12.1%. Incidence of reopening was highest after combined procedures (33.3%) and aortic surgery (33.3%). Reopening was performed in the operative theatre in 72.3% of cases, while 27.3% had reopening in the ICU. Risk factors for re-opening were longer average CPB (127 minutes vs 107 minutes) and aortic clamp times (71 vs 65 minutes). Patients who had reopening spent on average 55.45 hours on mechanical ventilation, while those who did not were extubated after 32 hours. The overall mortality rate was 11%; however, mortality in the reopening group was much higher (36.4%). Those who were reopened in ICU were at an older age (mean 61.6 vs 56.9 years), required more blood transfusions (mean 2.4 units vs 1.5 units) and had higher mortality (mean 60% vs 23.5%). Conclusions: Incidence of re-opening after cardiac surgery was 12.1%. The two main causes of re-opening were excessive bleeding and haemodynamic instability. Higher incidence of mortality was seen when re-opening took place in the ICU. Predictors for re-opening are old age, more complex (combined) procedures, aortic surgeries and prolonged cardiopulmonary bypass (CPB) and aortic cross clamp (ACC) durations.