Planned Reoperation after Cardiac Surgery in the Cardiac Intensive Care Unit

TL;DR

This study shows that re-exploration for bleeding after heart surgery can be safely done in the cardiac intensive care unit.

Contribution

The study demonstrates that planned reoperations in the CICU are not associated with higher complication risks or mortality.

Findings

72 patients underwent planned re-exploration for bleeding, with 21 in the CICU and 51 in the OR.

CICU reoperations were not an independent risk factor for major complications or mortality.

Re-exploration was mostly performed within 12 hours of the primary operation.

Abstract

Cardiac surgical re-exploration for bleeding is associated
with increased morbidity and mortality. Whether to perform these procedures in
the operating room (OR) or the Cardiac Intensive Care Unit (CICU) in uncertain.
We sought to determine if the location of the reoperation would affect
postoperative outcomes when a reoperation for bleeding is required following
cardiac surgery.

Patients who underwent planned cardiac
re-explorations for bleeding at our center from January 2019 to December 2021
were retrospectively enrolled in this study. Patient outcomes were compared and
analyzed.

Due to hemorrhagic shock, 72 patients underwent
planned cardiac re-explorations, including 21 operated in the CICU and 51 in the
OR. Within 12 h of the primary operation, 65 re-explorations (90.3%) were
performed. The peak Vasoactive-Inotropic Score was 47.0 ± 27.4, systolic
blood pressure was 89.4 ± 9.6 mmHg, central venous pressure was 12.1
± 4.4 cmH2O, and the serum lactate was 5.5 ± 4.1 mmol/L prior to
the reoperation. Multivariate logistic analysis showed that a reoperation
performed in the CICU was not an independent risk factor for the occurrence of
major complications. There was no significant difference in mortality between the
two groups.

Planned re-exploration for bleeding following
open cardiac surgery in the CICU is feasible and safe.

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