[Bleeding after cardiac surgery: risk factors, frequency, and outcomes]. / Kraujavimas po sirdies operaciju: rizikos veiksniai, daznumas, baigtys.

UNLABELLED: According to the data from different cardiac surgery centers, the incidence of urgent repetitive resternotomy for bleeding after cardiac on-pump operations varies from 2 to 5%. The aim of the study was to determinate the risk factors influencing resternotomy after cardiac surgery, features of early postoperative period, and outcomes. MATERIAL AND METHODS: Altogether, 37 consecutive patients undergoing urgent resternotomy due to bleeding early after cardiac surgery were analyzed retrospectively. Urgent resternotomies made up 4.3% of all cardiac on-pump surgeries performed on 856 patients at the Clinic of Cardiac Surgery of Kaunas University of Medicine Hospital during 2004. The mean age of patients was 64.9+/-12.9 years; 29.7% of patients were women and 70.3% were men. RESULTS: During analysis of preoperative clinical data factors that could influence coagulation status were determined. Twenty patients (54.1%) had moderate hypertension, three patients (8.1%) had severe insulin-dependent diabetes mellitus, and five patients (13.5%) had chronic renal insufficiency treated with dialysis. Assessing other risk factors it was observed that many patients were on peroral anticoagulation therapy before surgery. The most frequently administered drugs preoperatively were aspirin (16 cases, 43.2%) and direct-acting anticoagulants (17 cases, 45.9%). CONCLUSIONS: The use of antiaggregants and anticoagulants before surgery increases the incidence of resternotomies in the early postoperative period. Postoperative infections that require more expensive treatment with antibiotics are detected much more frequently in patients after resternotomies comparing to the remaining postoperative cardiac patients (15/37 and 69/819, respectively). However, longer hospitalization length (15.8 and 58.0 days, respectively) and higher mortality rate (4.5 and 10.8%, respectively) were observed in patients after resternotomy.

[Abnormal gastrointestinal findings in patients with coronary disease revealed by endoscopy before cardiac surgery]. / Ligoniu, serganciu isemine sirdies liga, virskinamojo trakto patologija, endoskopinio tyrimo duomenimis.

OBJECTIVES: To assess incidence of different abnormal gastrointestinal changes revealed by endoscopy before cardiac surgery in different female and male age groups and to establish criteria for carrying out preventive endoscopy in patients with coronary disease. MATERIAL AND METHODS: Retrospective analysis was performed on 3847 patients (63.2% and 36.8% of male and female patients, respectively; mean age 61.9+/-11.9) who underwent fiberoptic esophagogastroduodenoscopy (FEGDS) before cardiac surgery under extracorporeal circulation at Kaunas University of Medicine Hospital in 2000-2003. Study population was divided into two groups: group I consisted of 2348 (61%) patients whose endoscopy revealed active bleeding from mucous membranes of gastrointestinal tract (bleeding gastric or duodenal ulcer) or any other abnormal findings indicating bleeding potential (gastric and duodenal erosion or ulcer); group II comprised 1499 (39%) patients whose endoscopy revealed no abnormal changes or the revealed ones (scars, hiatal hernia, etc.) that cannot cause bleeding. RESULTS: No statistically significant differences were established in male and female percentage both generally and individually in groups (63.2% and 36.8% in all population studied; 61% and 39%, 64.6% and 35.4% in group I and group II, respectively). Further data analysis showed that FEGDS revealed changes requiring pre-surgical treatment in even 62.4% of male patients; meanwhile the similar changes were diagnosed in 58.7% of female patients. Incidence analysis of abnormal changes in terms of patient age established that even 31.1% of the group I population were patients aged 61-70, and 26.5%--patients aged 51-60. It should also be noted that these age groups were represented in the most ample manner in all population studied--31.7% (1209 patients) and 26.5% (1012 patients), respectively. The highest incidence of bleeding potential changes in male patients was found in the 51-60 year-old group (30.7% (462 patients)) and 61-70 year-old group (29% (436 patients)); in female patients, the highest incidence was observed in the 61-70 year-old group (35.2% (290 patients)) and 71-80 year-old group (25.6% (211 patients) (p<0.05). Data analysis showed that just 20.1% and 10.9% of male and female patients respectively were diagnosed with the changes mentioned in the age groups of up to 50 year-old. The study established that only 14.5% of FEGDS carried out revealed no abnormal changes in the upper gastrointestinal tract. CONCLUSION: Abnormal gastrointestinal changes indicating bleeding potential were established with significantly higher incidence in male compared with female patients. Gastrointestinal endoscopy before cardiac surgery under extracorporeal circulation should be carried out in 50-70 year-old male patients and 60-80 year-old female patients, while carrying out of the same examination in the younger and older patients is subject to additional indications. Only 14.5% of fiberoptic esophagogastroduodenoscopies carried out revealed no abnormal changes in the upper gastrointestinal tract.