Chest reexploration in the intensive care unit after cardiac surgery: a safe alternative to returning to the operating theater.

BACKGROUND: The aim of this study was to determine the outcome of patients who had chest reexploration in the intensive care unit (ICU) for bleeding or cardiovascular instability after heart surgery. METHODS: This was a retrospective analysis of medical records of patients who had a chest reexploration in the ICU for bleeding or possible cardiac tamponade over a 9-year period (1991 to 2000), at the Cardiothoracic Centre of Manchester Royal Infirmary, England. RESULTS: Between 1991 and 2000, 240 patients (3.4% of the total heart operations) who fitted the above criteria were identified. Two hundred and seven (86%) were reexplored for bleeding, 22 (9%) for possible tamponade, and 11 (5%) for both. Ninety-five percent were reexplored within 24 hours (median, 5 to 6 hours). Two hundred and twenty-six patients were found to have bleeding on reexploration. Of these, 125 (55%) were found to have focal bleeding, 74 (33%) diffuse bleeding, and 11 (5%) both. Two hundred and twelve (88%) had their chest closed, 25 (12%) packed, and 13 (10%) had further chest openings while in ICU. Sixteen (6.7%) of the patients died. Seven (2.9%) had sternal wound infection. For the survivors, ICU stay ranged from 1 to 60 days (median, 1) and their hospital stay ranged from 2 to 90 days (median, 8). CONCLUSIONS: Chest reexploration in ICU for bleeding or tamponade after heart surgery can be a safe alternative to return to the operating theater.

Outcome of primary chest packing and delayed sternal closure for intractable bleeding following heart surgery.

Post-operative bleeding is a life-threatening complication encountered following cardiac surgery. In cases where bleeding cannot be controlled by correcting clotting derangements and using standard surgical techniques, packing the chest may be an important salvation method. The aim was to determine the outcome of patients having primary chest packing in theatre for intractable bleeding following heart surgery. The method used was retrospective analysis of patients' medical records. Over a 9-year period, 6890 patients had open-heart surgery at the Manchester Royal Infirmary. Twenty (0.29%) of these patients had their chests packed prior to leaving theatre, 19 for uncontrolled bleeding, and one for inaccessible bleeding. Five (25%) of these patients required one further packing. The majority of patients (85%) survived. None developed a sternal wound infection. The conclusion drawn was that chest packing could be a life-saving procedure following heart surgery.