GKD Anest Yoð Bak Dern Derg. 2018; 24(4): 160-164 | DOI: 10.5222/GKDAD.2018.59454

Açýk kalp cerrahisi sonrasýnda kanama nedenli reoperasyonlar: Cerrahi kanama mý ? Koagülopati mi ?

Gökçe Selçuk Sert¹, Þule Dede¹, Zeliha Aslý Demir¹, Utku Ünal², Ayþegül Özgök^1
1Türkiye Yüksek Ýhtisas Eðitim Araþtýrma Hastanesi,anesteziyoloji Ve Reanimasyon Kliniði Sýhhýye,Ankara,Türkiye
²Türkiye Yüksek Ýhtisas Eðitim Araþtýrma Hastanesi Kardiyovasküler Cerrahi Kliniði Sýhhýye,Ankara,Türkiye

GÝRÝÞ ve AMAÇ: Açýk kalp cerrahisinde kanama nedenli reoperasyon mortalite ve morbiditeyi arttýran ciddi bir risk faktörüdür. Bu çalýþmadaki amacýmýz, kanama nedeni ile reoperasyona alýnan hastalarda, cerrahi ve koagülopati kanamasý için olabilecek preoperatif ve intraoperatif risk faktörlerini araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Hastalarýn verileri, hastane elektronik sisteminden ve hastalarýn dosyalarýndan elde edildi. Kalp yetmezliði ameliyatlarý haricinde, kardiyopulmoner baypas (KPB) kullanýlan tüm yetiþkin açýk kalp ameliyatý vakalarý çalýþmamýza dahil edildi. 2017 yýlýnda 1200 hasta arasýnda postoperatif kanama nedeniyle 24 saat içinde en az bir operasyon geçiren 77 hasta incelendi. Kanamalarý cerrahi ve koagülopatik olarak sýnýflandýrýldý. Revizyon sýrasýnda devam eden aktif kanama ve/veya sýzma olmaksýzýn hematom varlýðý koagülopatik kanama olarak tanýmlandý. Cerrahi kanama ise sütür veya klips gerektiren spesifik kanamalar olarak tanýmlandý.
BULGULAR: Postoperatif kanama nedeniyle 24 saat içinde en az bir operasyon geçiren 77 (% 6,4) hastanýn 71 tanesinin tam verilerine ulaþýlabildi. 28(%39,5) hastada cerrahi kanama ve 43(%60.5) hastada koagülopatik kanama tespit edildi. Preoperatif ve intraoperatif dönemde kanama tipi açýsýndan risk faktörü olabilecek deðiþkenler analiz edildi ancak iliþkili faktör bulunmadý.
TARTIÞMA ve SONUÇ: Hastalarýn% 39,5'inde cerrahi kanama tespit edildi. Literatürde diðer serilerde % 56.4 oranýnda cerrahi kanama oraný saptandý. Deneyimi yüksek olan kalp merkezimizde cerrahi kanama oraný, koagülopati kanamasýna göre daha düþük saptandý, az hasta sayýsý nedeniyle risk faktörlerini ayýrt etmek mümkün olmadý.

Anahtar Kelimeler: : postoperatif kanama, kardiyak cerrahi, koagülopati, kardiyak anestezi, hemostaz, reoperasyon

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Reoperations due to bleeding after open heart surgery: surgical bleeding? Coagulopathy?

Gökçe Selçuk Sert¹, Þule Dede¹, Zeliha Aslý Demir¹, Utku Ünal², Ayþegül Özgök^1
1Department Of Anesthesiology, Turkey Yüksek Ihtisas Training And Research Hospital, Sýhhýye, Ankara, Turkey.
²Department Of Cardiac Surgery, Turkey Yüksek Ihtisas Training And Research Hospital, Sýhhýye, Ankara, Turkey

INTRODUCTION: Reoperation is a risk factor that increases the postoperative mortality and morbidity of cardiac surgery patients. Our aim in this study is to investigate the rates of bleeding-induced reoperation, preoperative and intraoperative risk factors for surgical or coagulopathy bleeding.
METHODS: Perioperative patient data were collected from hospital electronic system and patient’s files.We included all cases of adult open heart surgery using cardiopulmonary bypass,except for cases of heart failure surgeries. 1200 patients found, 77 patient have undergone at least one operation within 24 h due to postoperative bleeding(%6,4).We classified the bleeding as surgical and coagulopathic. Haematoma without ongoing bleeding and/or oozing was defined as coagulopathic bleeding, and spesific bleeding requiring suture or clips was defined as surgical bleeding.
RESULTS: 71 were available in the data of patients. 28(39.5%) patients had surgical bleeding, and 43(60.5%) patients had coagulopathic bleeding. When the variables that might be a risk factor in terms of type of bleeding in preoperative and intraoperative period were examined, no related factors were found.
DISCUSSION AND CONCLUSION: Surgical bleeding was detected in 39.5% of the patients. Surgical bleeding rate was 56.4% in other series in the literature. At our heart center with high experience, surgical bleeding rate was lower than coagulopathy bleeding and it was not possible to distinguish the risk factors because of the small number of patients.

Keywords: cardiac surgery, bleeding, coagulopathy, reexploration, cardiac anesthesia, hemostazis, reoperations

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