Incidence of reexploration in cardiac surgery under cardio pulmonary bypass

Shakir, H R (2007) Incidence of reexploration in cardiac surgery under cardio pulmonary bypass. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Cardiac Surgery being the most modern and conceptualized surgery which involves cardiopulmonary bypass Clotting Mechanism, Temperature Control, Haemodilution and Cardiolegic arrest, etc. The failure off any off these mechanisms ends up in a cascading effect of morbidity and mortality of the patients. The complications associated in the post operative period like cardiac failure renal dysfunction, pulmonary dysfunction and cerebrovascular accident play a major role in determining the outcome. Post operative bleeding and Reexploration are inherent complications associated with cardiac surgery. The Adverse out come as a result of postoperative bleeding and Reexploration has been the subject of the present study. AIMS OF THE STUDY: The present study was primarily undertaken to study the incidence off Reexploration in Cardiac Surgery among patients subjected to cardio pulmonary bypass at department off cardio thoracic surgery, Madras Medical College, Chennai. Thereby identifying the factors contributing to Reexploration and adapting suitable measures to reduce the incidence of Reexploration. Reexploration remains a inherent complication associated with open heart surgery which in turn contributes towards increased morbidity, prolonged hospitalization infection, multiple organ dysfunction and even death. OBJECTIVES: To assess mortality and risk factors associated with Reexploration for hemorrhage in patients under going open heart surgery. To initiate appropriate steps in reducing the incidence of Reexploration. During the course of this study an effort has been made to highlight the cost off hospitalization resulting from Reexploration. The incidence of complications resulting from the same and the their management. The pre, intra and post operative measures that play a vital role have been stressed upon. MATERIALS AND METHODS: The present study was conducted at Department of Cardio thoracic Surgery, Madras Medical College, Govt. General Hospital, Chennai. From September 2004 to March 2007. Among 1131 patients who underwent cardiac surgery under cardio pulmonary bypass. Patients who had problem of bleeding underwent Reexploration. An overall incidence of Reexploration was 2.12% (24 / 1131) of patients. Patients included in the study belonged to both sexes and age groups varying from 11 to 68 years. The patients were subjected to routine investigations. CONCLUSIONS: Attention towards meticulous haemostasis prior to closure is Mandatory. Sound surgical technique will reduce incidence of bleeding from sites of Cannulation and Anastomosis. Adoption OFF PUMP CABG has shown to reduce incidence of post operative bleeding and Morbidity when compare to ON PUMPCABG. Adoption of Hemostatic Technique for internal mammary artery anastomotic bleeding by which hemostasis can be achieved without the risk of anastomotic stenosis or aggravation of the bleeding, as it avoids placing sutures over the anastomotic suture line. Patients predicted to have increased risks of bleeding may benefit from prophylactic use of aprotinin, aminocaproic acid, or other agents shown to reduce hemorrhage. The inherent risk of complications in a patient undergoing Open Heart Surgery can the avoided by encouraging TRANSCATHETER, MITRAL VALVOPLASTY, AORTIC VALVOPLASTY, PULMONARY VALVOPLASTY, and clam shell closure of ATRIAL SEPTAL DEFECT.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Incidence ; reexploration ; cardiac surgery ; cardio pulmonary bypass
Subjects: MEDICAL > Cardio Vascular and Thoracic Surgery
Depositing User: Kambaraman B
Date Deposited: 10 Nov 2017 17:01
Last Modified: 10 Nov 2017 17:01

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