Incidence of reexploration in cardiac surgery under cardiopulmonary bypass at Government Mohan Kumaramangalam Medical College Hospital, Salem

ABSTRACT

Background: Cardiac Surgery being the most modern and conceptualized surgery which involves cardiopulmonary bypass Clotting Mechanism, Temperature Control, Hemodilution, and Cardioplegic arrest, etc. The failure of any of these mechanisms ends up in a cascading effect of morbidity and mortality of the patients. The aim of the study The present study was primarily undertaken to study the incidence off Reexploration in Cardiac Surgery among patients subjected to cardiopulmonary bypass, thereby identifying the factors contributing to Reexploration and adopting suitable measures to reduce the incidence of Reexploration. Materials and methods: Totally 25 patients who underwent cardiac surgery under cardiopulmonary bypass Department of Cardio-Thoracic Surgery, Government Mohan Kumaramangalam Medical College Hospital, Salem. Patients who had a problem of bleeding underwent Reexploration. Patients included in the study belonged to both sexes and age groups varying from 11 to 68 years. The patients were subjected to routine investigations. Results: It was as high as 25% among the patient belonging to three different age groups (20-30), (40-50) and (50-60). The incidence of Reexploration was 58.3% (14/24) among patients who were CPB time exceeded 120 minutes. The overall incidence of Reexploration following open heart surgery was 1.38% (7/25). Among the patients to underwent Reexploration. Patients who underwent open Heart Surgery accounted for 29.16% (7/25) of patients. The incidence of Mortality in this group Pon. A. Rajarajan. Incidence of reexploration in cardiac surgery under cardiopulmonary bypass at Government Mohan Kumaramangalam Medical College Hospital, Salem. IAIM, 2019; 6(4) 20-25. Page 21 was 28.57% (2/7) of patients. Among the 7 patients who had Reexploration 71.4% (5/7 of patients had an uneventful course after Reexploration). 7 Patients who had valve replacement surgery accounted for among the total of 25 patients who had an undergone Reexploration accounting for 29.1% of all cases of Reexploration. 71.4% (5/7) who had undergone Mitral Valve replacement patients accounted for 71.4% (5/7) of Reexploration. Aortic valve replacement patients accounted for 14.2% (1/7). Double Valve replacement patients accounted for 14.2% (1/7). Overall Mortality following Reexploration in this group was 71.42% (5/7). 7 Patients who had a Reexploration after Valve replacement Surgery 28.5% (2/7) of the patients were undergoing Mitral Valve Replacement for Restenosis. One patient who was Reexplored for Post-operative bleeding had a Left Ventricle Free Wall rupture following Mitral Valve Replacement. Conclusion: Attention towards meticulous hemostasis prior to closure is Mandatory. A sound surgical technique will reduce the incidence of bleeding from sites of Cannulation and Anastomosis. Adoption OFF PUMP CABG has shown to reduce the incidence of postoperative bleeding and Morbidity when compare to ON PUMPCABG.