2008, Number 3
<< Back Next >>
Arch Cardiol Mex 2008; 78 (3)
Factores relacionados con hemorragia mayor durante la cirugía cardíaca bajo circulación extracorpórea
Hernández-González MA, Solorio S, Luna-Quintero C, Araiza-Guerra A, Cruz-Cervantes R, Luna-Ramírez S, Murillo-Ortiz B, Cruz-Márquez-Rico LM
Language: Spanish
References: 16
Page: 273-278
PDF size: 119.95 Kb.
ABSTRACT
Objective: To evaluate the risk factors related to bleeding in patients subjected to cardiac surgery using an extracorporeal circulation pump.
Material and methods: A study of cases and controls was designed performed in adults, matched by age and gender with indication of elective cardiac surgery using an extracorporeal circulation pump. Those patients with hepatic failure or blood coagulation disorders were excluded. Results were analyzed by Student t test, chi-square, and logistic regression analysis, considering p values significant at ‹ 0.05.
Results: The patients with functional class III or IV of the CCS presented more bleeding (p = 0.006), although there were no differences when comparing the ejection fraction in both. Obesity, dyslipidemia, and arterial hypertension were identified as risk factors. The coronary artery bypass graft, multivessels bypass surgery, and prolonged surgical times are associated to the complication (p ‹ 0.05). According to the discriminant function analysis, the cardiopulmonary derivation time, weight, aortic clamp time, and heparin doses are the factors that better discriminate the possibility of hemorrhage.
Conclusions: Heavy bleeding is related to ischemic patients, longer cardiac surgery time, overweight, and heparin doses during surgery.
REFERENCES
Hillegass W, Brott B, Chapman G, Phillips H, Stack R, Tcheng J, et al: Relationship between activated cloting time during percutaneus intervention and subsequent bleeding complications. Am Heart J 2002; 144: 501-507.
Pleym H, Stenseth R, Wahba A, Bjella L, Tromsdal A, Karevold A, et al: Prophylactic treatment with desmopressin does not reduce postoperative bleeding after coronary surgery in patients treated with aspirin before surgery. Anesth Analg 2004; 98: 578-584.
Sirlak M, Eryilmaz S, Yazicioglu L, Kiziltepe U, Eyileten Z, Durdu MS, et al: Comparative study of microfibrillar collagen hemostat (Colgel) and oxidized cellulose (Surgicel) in high transfusion-risk cardiac surgery. J Thorac Cardiovasc Surg 2003; 126: 666-670.
Silberstein L, Kruskall M, Sthling L, Johnston M, Rutman R: Strategies for the review of transfusion practices. JAMA 1989; 262: 1993-1997.
Pearl T: Effectiveness of transfusion audits and practice guidelines. Arch Pathol Med 1994; 118: 435-437.
Pothula S, Sanchala VT, Nagappala B, Inchiosa MA Jr: The effect of preoperative antiplatelet/anticoagulant prophylaxis on postoperative blood loss in cardiac surgery. Anesth Analg 2004; 98: 4-10.
Kurki TS, Kataja MJ, Reich DL: Validation of a preoperative risk index as a predictor of perioperative morbidity and hospital costs in coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 2002; 16: 401-404.
Cremer J, Martin M, Redl H, Bahrami S, Abraham C, Graeter T, et al: Systemic inflammatory response syndrome after cardiac operations. Ann Thorac Surg 1996; 61: 1714-1720.
Lincoff AM, LeNarz LA, Despostis GJ, Smith PK, Booth JE, Raymond RE, et al: Abxicimab and bleeding during coronary surgery: results from EPILOG and EPISTENT trials. Ann Thorac Surg 2000; 70: 516-526.
Karski JM, Teasdale SJ, Norman P, Carroll J, VanKessel K, Wong P, et al: Prevention of bleeding after cardiopulmonary bypass with high-dose tranexamic acid. Double-blind, randomized clinical trial. J Thorac Cardiovasc Surg 1995; 110: 835-842.
Hewitt Ch, Marra S, Kann B, Tran H, Puc M, Chrzanowski F Jr, et al: BioGlue surgical adhesive for thoracic aortic repair during coagulopathy: efficacy and histopathology. Ann Thorac Surg 2001; 71: 1609-1612.
Hassantash SA, Mirpoor K, Afrakhteh M: Cardiac surgery in an Iranian teaching hospital: outcome and risk factors. Asian Cardiovascular Thorac Ann 2004; 12: 312-315.
Whitlock R, Crowther MA, Ng HJ: Bleeding in cardiac surgery: Its prevention and treatment- an evidence-based review. Crit Care Clin 2005; 21: 589-610.
St. André AC, Delrossi A: Hemodynamic management of patients in the first 24 hours after cardiac surgery. Crit Care Med 2005; 33: 2082–2093
Panos A, Orrit X, Chevalley C, Kalangos A: Dramatic post-cardiotomy outcome, due to severe anaphylactic reaction to protamine. Eur J Cardiothorac Surg 2003; 24: 325-327.
Morel DR, Zapol WM, Thomas SJ, Kitain EM, Robinson ER, Moss J, et al: C5a and thromboxane generation associated with pulmonary vaso- and broncho-constriction during protamine reversal of heparin. Anesthesiology 1987; 66: 597-604