REOPERATIONS FOR BLEEDING AFTER CORONARY-ARTERY BYPASS PROCEDURES DURING 25 YEARS

Objectives and methods: To study the incidence, causes and risk factor s of reoperation for bleeding, 8563 coronary artery bypass procedures performed during 1970-1994 were reviewed. Results: Patients operated o n during 1990-1994 were older, the internal mammary artery was used mo re frequently, more grafts were inserted, more combined and redo bypas s procedures were performed than during 1970-1989. There were 402 earl y resternotomies but in 24 patients (6%) no bleeding was encountered a nd the compromised haemodynamics was caused by left ventricular failur e. Postoperative bleeding caused reoperation in 378 patients (4.4%). T here were 3.2% reoperations in 1994. The internal mammary artery or it s bed was the main cause of the bleeding in 43%. The reoperations were performed earlier and emergent reoperations because of cardiac tampon ade were less common during 1990-1994 than during 1970-1989. Reoperati on for bleeding was required in 8.6% of patients 80 years of age and o lder. 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 analys is predicted old age, combined procedure, early year of surgery and us e of the internal mammary artery as risk factors of reoperation for bl eeding. The risk of reoperation was not significantly related to numbe r 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. (C) 1997 Else vier Science B.V.