Prevention of Peri-Operative Cardiac Tamponade for Bleeding After C.A.B.G: Risk Factors, Outcomes, and The Effect of Left Partial Pericardiotomy and Early Re-Exploration

Mir Mohammad Sadeghi and Hassan

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Corresponding Author E-mail: Sadeghimirmohammad11@yahoo.com

DOI : http://dx.doi.org/10.13005/bbra/2383

ABSTRACT: we sought to determine whether Partial Left Pericardiotomy (PLP) and early re-exploration add incremental values in preventive Pericardial Tampered (PT) in post coronary artery bypass surgery patients. we aimed to identify risk factors for pericardial tapenade for bleeding after surgical revascularization in our practice. In all, 20000 consecutive patients undergoing only CABG between March 1, 2004 to May 30, 2015 were retrospectively analyzed from our cardiac surgery data base registry. Multivariate logistic regression analysis was based to identify risk factors for pericardial tamponade (PT) after bleeding to assess the effect of partial left pericardiotomy (PLP), pericardial tamponade patients were Propensity matched as with unique patients having PLP done in them routinely. Also results of early timing re-exploration in CABG’s were analyzed. A total number of 625 patients out of 20016 CABG cases underwent re-exploration for pericardial tamponades (PT) Multivariate analysis revealed that by not opening the left pleural space it significantly increased the risks of tamponade. Propensity matched analysis showed that preoperative opening of left partial pericardiotomy into left pleural space were associated with decreased risk of cardiac tapenade in patients undergoing Open Heart Surgery whether on-pump or off-pump. There was a significant difference in the mortality rate. Adverse outcomes were significantly higher when patients waited more than 12 hours after the end of operation and return to the ICU for re-exploration due to bleeding post operatively. One of the greatest risk factors for re-exploration for bleeding after open heart surgery is cardiac tamponade and delay in re-exploration. Patients in need of re-exploration are at higher risk of complications if we have not opened up the left pleural space via partial left pericardiotomy and if the time of re-exploration is delayed. Policies that promote opening up left pleural space and prompt early return to the operating room for re-exploration should be encouraged.

KEYWORDS: Partial Left Pericardiotomy (PLP); Pericardial Tamponade (PT); Coronary Artery Bypass Grafting (CABG); Intra-Aortic Balloon Pump (IABP)

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