Objective

Re-exploration after cardiac surgery is associated with an increase in morbidity and mortality. We sought to evaluate the relative frequency of sites of active bleeding identified intraoperatively as the cause for return to theatre.

Methods

Prospectively collected data were obtained for all patients who underwent general cardiac surgery at our institution between January 2008 and December 2012. Student's t-test and Pearson's Chi-squared test were used for statistical analysis.

Results

8,477 patients were operated in the period studied, with 435 (5.1%) requiring re-exploration. The intraoperative findings were documented in 386 (88.7%). The commonly identified causes of bleeding were: diffuse coagulopathic 21.2% (n=82), graft conduit 12.7% (n=49), aortotomy 10.4% (n=40), sternal wire holes 10.1% (n=39), distal coronary anastomoses 9.8% (n=38), soft tissue vessels 8.0% (n=31), sternum 7.8% (n=30), cannulation sites 6.5% (n=25), and proximal coronary anastomoses 5.7% (n=22).

Conclusion

Over 90% of surgical causes of re-exploration after cardiac surgery may be localised to eight sites. Greater attention to these prior to chest closure may reduce both postoperative bleeding, and the return to theatre rate; with attendant benefit to morbidity and mortality in the postoperative period.