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.