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Age and Left Ventricular Impairment Predict Reopening for Bleeding

Department of Cardiothoracic Surgery
¹ Westmead Millennium Institute, Westmead Hospital, Sydney, Australia

For reprint information contact: Hugh S Paterson, FRACS Tel: 61 2 98457994 Fax: 61 2 98458314 email: patersonh{at}aol.com Department of Cardiothoracic Surgery, Westmead Hospital, Hawkesbury Road, Westmead, NSW, 2145, Australia.

Statistical analysis of data collected prospectively from all patients undergoing surgery under cardiopulmonary bypass from September 1994 to November 1998 (group 1) was performed to identify preoperative risk factors for reopening for bleeding. Multiple logistic regression analysis of 19 preoperative variables was carried out with reoperation for bleeding as the endpoint. The protocol for intraoperative use of aprotinin was then changed to include high-risk patients. Data collected from all subsequent patients from May 1999 to March 2002 (group 2) were analyzed. Subgroup analyses on primary isolated coronary artery surgery were also performed. Data were obtained from 1,946 patients aged 22 to 88 years (mean, 62.5 years). Older age, severe left ventricular impairment, redo surgery, and chronic renal failure were the independent predictors of reopening for bleeding in group 1. There were no independent predictors of reopening in group 2. Older age and chronic renal failure were the predictors of reexploration for bleeding in patients undergoing primary isolated coronary artery grafting. Prophylactic measures to prevent excessive bleeding should be used in elderly patients and those with severe left ventricular impairment, redo surgery, and chronic renal failure.