University of Oulu

Fausto Biancari, Eeva-Maija Kinnunen, Tuomas Kiviniemi, Tuomas Tauriainen, Vesa Anttila, Juhani K.E. Airaksinen, Debora Brascia, Francesco Vasques, Meta-analysis of the Sources of Bleeding after Adult Cardiac Surgery, Journal of Cardiothoracic and Vascular Anesthesia, Volume 32, Issue 4, 2018, Pages 1618-1624, ISSN 1053-0770,

Meta-analysis of the sources of bleeding after adult cardiac surgery

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Author: Biancari, Fausto1,2,3; Kinnunen, Eeva-Maija2; Kiviniemi, Tuomas3;
Organizations: 1Department of Surgery, University of Turku, Turku, Finland
2Department of Surgery, University of Oulu, Oulu, Finland
3Heart Center, Turku University Hospital and University of Turku, Turku, Finland
4Department of Anesthesia, Padua University Hospital, Padua, Italy
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
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Language: English
Published: Elsevier, 2018
Publish Date: 2019-10-21


Objective: The aim of this study was to pool data on the proportion and prognostic impact of sources of bleeding in patients requiring re-exploration after adult cardiac surgery.

Design: Systematic review of the literature and meta-analysis.

Setting: Multistitutional study.

Measurements and Main Results: A literature review was performed to identify studies published since 1990 evaluating the outcome after reoperation for bleeding or tamponade after adult cardiac surgery. Eighteen studies including 5,1497 patients fulfilled the selection criteria. Reoperation for bleeding/tamponade was performed in 2,455 patients (4.6%; 95% confidence interval [CI] 3.9%–5.2%, I² 92%). These had a significantly higher risk of in-hospital/30-day mortality compared with patients not reoperated for bleeding (pooled rates: 9.3% v 2.3%; risk ratio 3.30; 95% CI 2.52–4.32; I² 47%; 8 studies; 25,463 patients). Surgical sites of bleeding were identified in 65.7% of cases (95% CI 58.3%–73.2%; I² 94%), cardiac site bleeding in 40.9% of cases (95% CI 29.7%–52.0%; I² 94%), and mediastinal/sternum site bleeding in 27.0% of cases (95% CI 16.8%–37.3%; I² 94%). The main sites of bleeding were the body of the graft (20.2%), the sternum (17.0%), vascular sutures (12.5%), the internal mammary artery harvest site (13.0%), and anastomoses (9.9%). In metaregression, surgical site bleeding was associated with a lower risk of in-hospital/30-day mortality compared with diffuse bleeding (p = 0.003).

Conclusions: Surgical site bleeding is identified in two-thirds of patients undergoing re-exploration after adult cardiac surgery. Meticulous surgical technique and systematic intraoperative checking of potential surgical sites of bleeding at the time of the original cardiac surgery may reduce the risk of such a severe complication.

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Series: Journal of cardiothoracic and vascular anesthesia
ISSN: 1053-0770
ISSN-E: 1532-8422
ISSN-L: 1053-0770
Volume: 32
Issue: 4
Pages: 1618 - 1624
DOI: 10.1053/j.jvca.2017.12.024
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: © 2017 Elsevier Inc. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license