Læknablaðið - 15.09.2009, Qupperneq 25

FRÆÐIGREINAR
RANNSÓKN
14. Koren-Morag N, Goldbourt U, Tanne D. Poor functional
status based on the New York Heart Association classification
exposes the coronary patient to an elevated risk of ischemic
stroke. Am Heart J 2008; 155: 515-20.
15. Nashef SAM, Rogues F, Michel P, Gauducheau E, Lemeshow
S, Salamon R. European system for cardiac operative risk
evaluation (EuroSCORE). Eur J Cardio-Thorac Surg 1999; 16:
9-13.
16. Sethi GK, Copeland JG, Goldman S, Moritz T, Zadina K,
Henderson WG. Implications of preoperative administration
of aspirin in patients undergoing coronary-artery bypass-
grafting. J Am Coll Cardiol 1990; 15:15-20.
17. Mangano DT, the Multicenter Study of Perioperative
Ischemia Research Group. Aspirin and Mortality from
Coronary Bypass Surgery. N Engl J Med 2002; 347:1309-17.
18. Alghamdi AA, Moussa F, Fremes SE. Does the use of
preoperative aspirin increase the risk of bleeding in patients
undergoing coronary artery bypass grafting surgery?
Systematic review and meta-analysis. J Cardiac Surg
2007;22:247-56.
19. Dacey LJ, Munoz JJ, Johnson ER, et al. Effect of preoperative
aspirin use on mortality in coronary artery bypass grafting
patients. Ann Thorac Surg 2000; 70:1986-90.
20. Bybee KA, Powell BD, Valeti U, et al. Preoperative
aspirin therapy is associated with improved postoperative
outcomes in patients undergoing coronary artery bypass
grafting. Circulation 2005; 112:1286-192.
21. Kamran M, Ahmed A, Dar MI, Khan AB. Effect of aspirin on
postoperative bleeding in coronary artery bypass grafting.
Ann Thorac Cardiovasc Surg 2008; 14: 224-9.
22. Leong JY, Baker RA, Shah PJ, Cherian VK, Knight JL.
Clopidogrel and bleeding after coronary artery bypass graft
surgery. Ann Thorac Surg 2005; 80: 928-33.
23. Jones HU, Muhlestein JB, Jones KW, et al. Preoperative
use of enoxaparin compared with unfractionated heparin
increases the incidence of re-exploration for postoperative
bleeding after open-heart surgery in patients who present
with an acute coronary syndrome - Clinical investigation
and reports. Circulation 2002; 106:119-122.
24. Sigurjónsson H, Torfason B, Viðarsson BG, Guðbjartsson T.
Blæðing er aukin eftir kransæðahjáveituaðgerðir á sláandi
hjarta í samanburði við aðgerðir framkvæmdar með aðstoð
hjarta-og lungnavélar. Læknablaðið 2008; 94/suppl 55: 15
[abstract].
25. Leal-Noval SM, Rincon-Ferrari MD, Garcia-Curiel A, et
al. Transfusion of blood components and postoperative
infection in patients undergoing cardiac surgery. Chest 2001;
119:1461-8.
26. Chelemer SB, Prato BS, Cox PM, O'Connor GT, Morton
JR. Association of bacterial infection and red blood cell
transfusion after coronary artery bypass surgery. Ann
Thorac Surg 2002; 73:138-42.
27. Sigurjónsson H, Torfason B, Viðarsson BG, Guðbjartsson T.
Samanburður á kransæðahjáveituaðgerðum framkvæmdum
á sláandi hjarta og með aðstoð hjarta- og lungnavélar.
Læknablaðið 2007; 93: 328-9 [abstract].
28. Blóðbankinn. Handbók Blóðbankans. In: Björn Harðarson,
Marín Þórsdóttir, eds. 2 ed. Reykjavík; 2008.
29. Schneeweiss S, Seeger JD, Landon J, Walker AM. Aprotinin
during coronary-artery bypass grafting and risk of death. N
Engl J Med 2008; 358: 771-83.
30. Ingimarsson JP, Önundarson PT, Valsson F, Viðarsson B,
Guðbjartsson T. Árangur á notkun líftæknigerðs espaðs
storkuþáttar Vlla við meiriháttar blæðingum í opnum
hjartaskurðaðgerðum. Læknablaðið 2008; 94: 607-12.
Reoperation for bleeding following open heart surgery in lceiand
Introduction: Postoperative bleeding is a common and
potentially fatal complication following open heart surgery,
studies reporting a reoperation rate for bleeding in the
range of 2-6%. Surgical outcome after such reoperations
has not been previously studied in lceland.
Material and methods: In this retrospective study were
included all adults that underwent open heart surgery in
lceland during a 6 year period, between January 1,2000
and December 31,2005.
Results: There were 103 reoperations (mean age 68
years, 76% males), but throughout the same 6 year period
a total of 1295 open heart procedures were performed,
the reoperation-rate being 8%. One third of ail patients
were on aspirin and 8% on clopidogrel less than 5 days
before surgery. The bleeding in the primary operation
averaged 1523 ml (range 300-4780) and 3942 ml for the
first 24 hours postoperatively. Half of the patients were
reoperated on within 2 h and 97% within 24 hours. The
patients received on average 16.5 units of packed cells,
15.6 units of plasma and 2.3 sets of thrombocytes. The
most common postoperative complication was atrial
fibrillation (58.3%), pleural effusion that needed chest
tube drainage (24.3%), myocardial infarction (23.3%) and
sternal wound infection (11.7%). Median length of stay was
14 days (range 6-85), including 2 days (range 1-38) in ICU.
Operative mortality was 15.5% and 1 year crude survival
79.6%.
Conclusion: Reoperation-rate for bleeding was 8%, which
is higher compared to other studies. Bleeding is a serious
complication following open heart surgery with high
morbidity and significant mortality.
Smarason NV, Sigurjonsson H, Hreinsson K, Arnorsson T, Gudbjartsson T.
Reoperation for bleeding following open heart surgery in lceland. Icel Med J 2009; 95:567-573.
Key words: Postoperative bleeding, reoperation, open heart surgery, CABG, valve replacement, complications, transfusions, survival.
Correspondence: Tómas Guðbjartsson, tomasgud@iandspitaii.is
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Barst: 19. janúar 2009, - samþykkt til birtingar: 29. júní 2009
LÆKNAblaðið 2009/95 573
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