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Practical aspects in the recommendation for reoperation in immediate postoperative phase of cardiac surgery

Luís Alberto Dallan; Sérgio de Almeida Oliveira; Dalton A. F Chamone; José Carlos Rossini Iglézias; Geraldo Verginelli; Adib D Jatene

DOI: 10.1590/S0102-76381989000300007


Blood coagulation of 65 patients that needed reoperation to control excessive bleeding after cardiopulmonary bypass surgery was evaluated by hematologist that didn't know the reoperation findings. Forty-six (90.2%) of 51 patients with normal tests before the reintervention had localizated bleeding, and five (9.8%) had difuse hemorrhage. From 14 patients with abnormal coagulation tests, eight (57.2%) had difuse bleeding and six (42.8%) had a localizated bleeding. The authors concluded that with normal coagulation tests and excessive bleeding after cardiopulmonary bypass surgery a new reoperation is indicated. Otherwise, patients with abnormal coagulation tests can receive initial clinical treatment.


Foram estudados restrospectivamente os coagulogramas de 65 pacientes submetidos a revisão de hemostasia no pós-operatório imediato de cirurgia cardíaca. Os coagulogramas foram considerados compatíveis ou não com distúrbio da coagulação sangüínea, por hematologista que desconhecia o achado cirúrgico. Dentre 51 pacientes cujos valores do coagulograma foram considerados normais, 46 (90,2%) apresentavam sangramento ativo localizado, passível de correção cirúrgica. Os 5 (9,8%) demais pacientes apresentavam sangramento difuso. Dentre os 14 pacientes restantes, cujo coagulograma encontrava-se alterado, 8 (57,2%) apresentavam sangramento difuso e 6 (42,8%), localizado. Os autores concluem que, na persistência de sangramento excessivo pós-operatório e coagulograma normal, a revisão de hemostasia deverá ser prontamente indicada. Entretanto, se houver alteração do coagulograma, dever-se-à empregar, inicialmente, o tratamento clínico, desde que o ritmo do sangramento o permita. Caso o sangramento persista, mesmo com melhora do coagulograma, deverá ser pesquisada a presença de coágulos retidos no mediastino. Se positiva, deve-se programar nova toracotomia, visando à remoção de coágulos do mediastino.
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Article receive on Friday, October 20, 1989

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