개심술후 출혈로 인한 응급개흉술의 임상적 고찰

Emergency Reexploration for Bleeding after Open Heart Surgery wth Cardiopulmonary Bypass -A Report of 16 Cases-

Bleeding after open heart surgery with cardiopulmonary bypass was a cause of concern. requiring reexploration of the chest in approximately 8 percent of patients who have had operations on the heart. From April., 1983 to October, 1991, 16 patients[2%] out of 777 patients who underwent open cardiac surgery had emergency reexploration with bleeding at the Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital. In 12 cases[75%], reexploration was performed for continuous bleeding and the reminder[4 cases] were performed for suspected tamponade & hypotension. There were 9 cases[56%] of congenital heart disease and 7 cases of acquired heart disease. The mean blood loss were 997$\pm$472ml /sq. M in total cases and 1442$\pm$ 647ml /sq. M in cases repair of cyanotic heart disease. The mean interval till reoperation was 16.6hr [1hr~72hr] and 41 hr[12~72hr] in tamponade cases and 8.4hr[1hr~24hr] in continuous bleeding cases. The bleeding sites were identified in 7 cases: aortotomy site in 2 cases, ventriculotomy site, SVC, thymus, pleura and sternum wiring site in each other case. But no specific sites was found in the remaining 9 cases. The 8 cases had complications but all except 1 cases with hypoxic brain damage were recovered without sequale. We conclude that emergency thoractomy after open heart surgery may be lifesaving and-/or diminishing complications with bleeding if performed promptly with excessive bleeding, tamponade and unexpected hypotension.