Re-exploration after off pump coronary artery bypass grafting: incidence, risk factors and impact of timing

Abstract

Objective: Re-exploration after cardiac surgery still remained a troublesome complication. There is still scarcity of data about the effect of re-exploration after off-pump coronary arterial bypass grafting (OPCABG). We here represent our experience of re-exploration following OPCABG. Method: Total 5990 OPCABG were performed at our center, out-off these 132 (2.2%) patients were re-explored in the OR and were included in this study. The medical records of these patients were retrospectively reviewed. Results: The most common cause of re-exploration was bleeding (83.3%) and most common site of bleeding was from graft/anastomosis (53.8%). Mean time to re-exploration was 9.75±8.65 hours. 30-day mortality was 1.41%.On univariate and multiple regression analysis, emergency surgery, preoperative low platelet count, and number of grafts were found to be an independent risk factor for re-exploration. On multiple regression, emergency surgery, euroscoreII, low platelet count, low ejection fraction, re-exploration, time to re-exploration, blood products used, high post-op serum creatinine and bilirubin, were found to be an independent factor (p<0.001) for mortality. On receiver-operating characteristic analysis, optimum cut off for time to re-exploration was 14 hours with sensitivity 81.3%, specificity of 80% and area under curve of 0.798. Patients who re-explored late (>14 hour) had significantly high mortality (30.55%vs7.3%) and morbidity. Conclusion: Delaying the re-exploration is associated with three-fold increase in mortality and morbidity. So strategy of minimizing the incidence of re-exploration like use of minimally invasive surgery and early re-exploration with judicial use of products should be use to improve outcome after re-exploration following off-pump CABG.

Re‐exploration after off‐pump coronary artery bypass grafting: Incidence, risk factors, and impact of timing: Utility of haemostasis checklist

“…We greatly appreciate the interest and comments provided by Ali et al 1 for our article 2 “Re‐exploration after off‐pump coronary artery bypass grafting (OPCABG): Incidence, risk factors, and impact of timing.” Surgical checklists such as “World Health Organization Surgical Safety Checklist” are made to make surgery safer, simple, and to reduce human errors. Similar to this concept, Ali et al 1 and others 3 have implemented the “haemostasis checklist” and it had shown a reduction in the incidence of re‐exploration in patients who underwent surgery using cardiopulmonary bypass (CPB).…”

Re‐exploration and bleeding rates after cardiac surgery can be reduced—The utility of a checklist

“…We read with interest the recent study by Patel et al 1 The authors are to be commended on their extensive experience of nearly 6000 patients with off-pump CABG. From their series 2.2% of patients were re-explored for bleeding, highlighting that this is also an important problem for off-pump surgery.…”