Reoperations for bleeding after coronary artery bypass procedures during 25 years.

OBJECTIVES AND METHODS: To study the incidence, causes and risk factors of reoperation for bleeding, 8563 coronary artery bypass procedures performed during 1970-1994 were reviewed. RESULTS: Patients operated on during 1990-1994 were older, the internal mammary artery was used more frequently, more grafts were inserted, more combined and redo bypass procedures were performed than during 1970-1989. There were 402 early resternotomies but in 24 patients (6%) no bleeding was encountered and the compromised haemodynamics was caused by left ventricular failure. Postoperative bleeding caused reoperation in 378 patients (4.4%). There were 3.2% reoperations in 1994. The internal mammary artery or its bed was the main cause of the bleeding in 43%. The reoperations were performed earlier and emergent reoperations because of cardiac tamponade were less common during 1990-1994 than during 1970-1989. Reoperation for bleeding was required in 8.6% of patients 80 years of age and older. Combined coronary bypass surgery and intracardiac repair implied a 1.7 higher risk of reoperation for bleeding compared with patients undergoing primary isolated bypass surgery. Logistic regression analysis predicted old age, combined procedure, early year of surgery and use of the internal mammary artery as risk factors of reoperation for bleeding. The risk of reoperation was not significantly related to number of grafts inserted or if the patient had undergone previous cardiac surgery. Reoperation for bleeding increased the stay in intensive care by at least one day but did not increase the risk of wound infection. CONCLUSIONS: Special precautions seem indicated to reduce the risk of reoperation for bleeding in particularly elderly patients undergoing combined coronary surgery and other intracardiac repair.

Surgical correction of congenital left coronary-pulmonary artery fistula and rheumatic mitral valve disease. Case report.

A 56-year-old woman with stenosis and incompetence of the mitral valve and clinical signs of congestive heart failure was found to have a communication between the left anterior descending coronary artery and the pulmonary trunk. A mitral valve prosthesis was inserted and the fistula was closed from within the pulmonary artery.

Zinc and copper metabolism during open-heart surgery.

Zinc and copper changes were studied in plasma, whole blood, urine and myocardium in 15 patients undergoing valve replacement in hypothermic cardiopulmonary bypass with hemodilution. During the cardiopulmonary bypass, a fall in plasma copper and zinc concentration was related to hemodilution. The zinc concentration also decreased in whole blood, but remained unchanged intracellularly. The urinary concentration of both cations, but not the output, decreased at the end of the operation in relation to the baseline values. The myocardial copper and zinc concentrations increased during the aortic cross-clamping period. The possible causes and significance of these changes are considered.