Re‐exploration after off‐pump coronary artery bypass grafting: Incidence, risk factors, and impact of timing

• Published in: Journal of cardiac surgery Vol. 35; no. 11; pp. 3062 - 3069
• Main Authors: Patel, Kartik, Adalti, Sudhir, Runwal, Shreyas, Singh, Rahul, Ananthanarayanan, Chandrasekaran, Doshi, Chirag, Pandya, Himani
• Format: Journal Article
• Language: English
• Published: United States 01-11-2020
• Subjects: Aged; Bilirubin - blood; bleeding; Coronary Artery Bypass, Off-Pump - adverse effects; Coronary Artery Bypass, Off-Pump - methods; Coronary Artery Bypass, Off-Pump - mortality; Creatinine - blood; early re‐exploration; Emergency Medical Services; Female; Hemorrhage - epidemiology; Hemorrhage - etiology; Humans; Incidence; Male; Middle Aged; off‐pump coronary artery surgery; Platelet Count; Retrospective Studies; Risk Factors; Thrombocytopenia; Time Factors; Treatment Outcome; early re-exploration; off-pump coronary artery surgery; bleeding
• ISSN: 0886-0440; 1540-8191
• DOI: 10.1111/jocs.14986

Objective
Re‐exploration after cardiac surgery still remains a troublesome complication. There is still a scarcity of data about the effect of re‐exploration after off‐pump coronary artery bypass grafting (OPCABG). We here represent our experience on re‐exploration following OPCABG.
Method
A total of 5990 OPCABG were performed at our center, out of these patients, 132 (2.2%) were re‐explored in the operation room 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 the most common site of bleeding was from graft/anastomosis (53.8%). The mean time to re‐exploration was 9.75 ± 8.65 hours. The thirty‐day mortality was 1.41%. On univariate and multiple regression analysis, emergency surgery, preoperative low platelet count, and the number of grafts were found to be independent risk factors for re‐exploration. On multiple regression, emergency surgery, Euroscore II, low platelet count, low ejection fraction, re‐exploration, time to re‐exploration, blood products used, and high postoperative serum creatinine and bilirubin were found to be independent factors (P < .001) for mortality. On receiver‐operating characteristic analysis, the optimum cutoff for time to re‐exploration was 14 hours with a sensitivity of 81.3%, specificity of 80%, and area under the curve of 0.798. Patients who re‐explored late (>14 hours) had significantly high mortality (30.55% vs 7.3%) and morbidity.
Conclusion
Delaying re‐exploration is associated with a three fold increase in mortality and morbidity. So, a strategy of minimizing the incidence of re‐exploration, like the use of minimally invasive surgery and early re‐exploration with the judicial use of products, should be used to improve outcomes after re‐exploration following OPCABG.