Abstract
Objectives Re-exploration after cardiac surgery remains a frequent complication with adverse
outcomes. The aim of this study was to evaluate the impact of timing and indication
of re-exploration on outcome.
Methods A retrospective, observational study on a cohort of 209 patients, who underwent re-exploration
after cardiac surgery between January 2005 and December 2011, was performed. The cohort
was matched for age, gender, and procedure with patients who were not re-explored
during the same period.
Results The intraoperative and postoperative transfusion requirements were higher in the
re-exploration group (p < 0.01). Patients in the re-exploration group had significantly higher incidences
of postoperative acute renal injury (10.0 vs. 3.3%), sternal wound (9.1 vs. 2.4%)
and pulmonary (13.4 vs. 4.3%) infections, longer ventilation time (22 [range, 14–52]
vs. 12 [range, 9–16] hours) and intensive care unit stay (5 [range, 3–7] vs. 2 [range,
2–4] days), and higher mortality rate (9.6 vs. 3.3%). However, the multivariate logistic
regression analysis demonstrated that not the re-exploration itself, but the deleterious
effects of re-exploration (blood loss and transfusion requirement) were independent
risk factors for mortality. Mortality was 5.3% for patients who were re-explored within
the first 12 hours and 20.3% for patients who were re-explored after 12 hours (p = 0.003). Mortality was 3.6% for patients with bleeding and 31.4% for patients with
cardiac tamponade for indication of re-exploration (p < 0.001).
Conclusions This study suggests that re-exploration after cardiac surgery is associated with
increased mortality and morbidity. Patients with delayed re-exploration and suffering
from cardiac tamponade have adverse outcome.
Keywords
re-exploration - bleeding - tamponade - cardiac surgery
