Asad Khan, Riffat Tanveer, Amina Nasreen, Amin Khuwaja.
Effect of cardiopulmonary bypass duration on postoperative mediastinal bleeding with coagulopathy in coronary artery bypass graft (CABG) surgery.
Pak Heart J Jan ;51(4):309-13.

Objective: To determine the effect of cardiopulmonary bypass (CPB) duration asa risk factor in the incidence of postoperative mediastinal bleeding with coagulopathy in elective CABG surgery. Methodology: Our study was cross-sectional and retrospective done at Department of Cardiac Surgery and Anaesthesia at the National Institute of Cardiovascular Diseases, Karachi, from 1st February 2013 to 31st January 2015. The demographic, operative and postoperative data were collected. The time for CPB and aortic cross clamp time was noted. Postoperative mediastinal bleeding was measured through the mediastinal drains. The patients' prothrombin time /international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT), platelet count and haemoglobin were documented and the patients with significant mediastinal bleeding with raised PT/INR, aPTT and thrombocytopenia were treated conservatively with fresh frozen plasma,platelets and blood or surgical re-exploration if required. Analysis of Variance (ANOVA) was used to analyse the data and a p<0.05was considered statistically significant. Results: Total of 110 patients were included in the study. Our study revealed that the mean CPB time (minutes) was 75.2+-11.6 minutes (range: 62 to 137 minutes). In 5 patients (4.55%) the CPB time was greater than 100 minutes. Postoperative mediastinal bleeding was increased in 4 (3.64%) out of the five patients in whom the cardiopulmonary bypass time was greater than 100 minutes(p<0.05). Mean postoperative mediastinal bleeding of 1.5 ml/kg/hour occurred when the immediate postoperative blood platelet count was less than or equal to 90 X 10 /l (p < .05). In all these patients the PT/INR, APTT was raised above 9 4normal and there was thrombocytopenia (coagulopathy). Out of these 4 patients 3 (2.73%) patients were successfully treated conservatively with transfusion of fresh frozen plasma and platelets, while 01 (0.91%) patient required surgical reexploration as he developed cardiac tamponade. Conclusion: Prolonged cardiopulmonary bypass time is a risk factor for post CABG mediastinal bleeding with coagulopathy.

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