【JCM】 Early Reexploration vs Conservative Approach after CABG скачать в хорошем качестве

【JCM】 Early Reexploration vs Conservative Approach after CABG

Please LIKE and SUBSCRIBE if you enjoyed it! This video is adapted from 10.3390/jcm12093327 Encyclopedia MDPI: https://encyclopedia.pub/ Try our video production services: https://encyclopedia.pub/video_service Postoperative bleeding that necessitates re-exploration following cardiac surgery has been consistently linked to complications affecting both short-term outcomes and perioperative survival. However, the decision to return to the operating room remains a subject of debate, particularly in hemodynamically stable patients with substantial—though not rapidly accumulating—chest tube drainage. This study specifically examines the consequences of re-exploration in a borderline population of elective coronary artery bypass grafting (CABG) patients who experienced significant non-acute bleeding, without critical hemodynamic instability. From a prospectively maintained database of 8,287 patients undergoing primary isolated elective CABG, a cohort of 1,642 hemodynamically stable individuals was identified, all of whom had normal coagulation parameters and platelet counts but exhibited significant blood loss—defined as more than 1,000 mL over 12 hours, with less than 200 mL per hour in the initial 5 hours. Among these, 252 patients underwent re-exploration based on the attending surgeon’s discretion, while 1,390 were managed conservatively. Using propensity score matching to enhance comparability, the analysis revealed that patients who underwent reoperation required significantly more blood product transfusions, with 88.4% receiving packed red blood cells compared to 52.6% in the conservatively managed group. Furthermore, reoperated patients had markedly higher rates of respiratory complications, including prolonged mechanical ventilation, extended stays in the intensive care unit, and longer overall hospitalization. They also faced a significantly elevated risk of multiorgan failure and showed a trend toward increased perioperative mortality. These findings suggest that, in hemodynamically stable patients with significant but non-critical bleeding, a conservative approach may represent a safe and potentially advantageous alternative, associated with reduced postoperative morbidity and shorter hospital stays.