Early Outcomes of Re-Exploration for Bleeding After Elective Cardiac Surgeries in Adult Patients

Mohamed Elbalasy; Medhat Baragaa; Sherif Elboghdady; Sameh Elameen; Lamiaa Elshony

Mohamed Elbalasy National Heart Institute, Cairo, Egypt
Medhat Baragaa Nasser Institute Hospital, Cairo, Egypt
Sherif Elboghdady National Heart Institute,, Cairo, Egypt
Sameh Elameen National Heart Institute,, Cairo, Egypt
Lamiaa Elshony Department of Cardiothoracic Surgery, Faculty of Medicine for Girls, AlAzhar university, Cairo, Egypt

Keywords: Re-exploration, Bleeding, Cardiac surgery, Predictors, Mortality

Abstract

Background: Re-exploration for bleeding is a serious complication following elective cardiac surgery, consistently associated with increased morbidity, mortality, prolonged hospital stay, and greater use of healthcare resources. We aimed to investigate the causes of re-exploration for bleeding in adult cardiac surgery patients, determine its impact on the outcomes, and analyze the predictors of mortality.

Methods: A prospective observational study was conducted on 200 consecutive adult patients who underwent exploration for bleeding during 1450 elective cardiac surgeries between July 2024 and March 2025.

Results: The mean age was 49.18 ± 12.71 years, and 26.5% were females. Comorbidities included diabetes (22%), hypertension (42.5%), and smoking (58.5%). Mean preoperative EF was 58.18 ± 6.54%. Procedures included CABG (43%), mitral valve replacement (22%), double valve replacement (17.5%), aortic valve replacement (15%), and Bentall (2.5%). Mean cardiopulmonary bypass and cross-clamp times were 120.01 ± 35.32 and 88.31 ± 23.90 minutes, respectively. Early mortality was 7.5%. Major complications included shock (4.5%), massive transfusion (18%), and renal failure (2%). Most re-explorations occurred within 6–12 hours (47%). Bleeding was surgical in 81.5% and medical in 18.5%. Multivariable regression identified prolonged mechanical ventilation as a significant predictor of early mortality (OR = 1.226, p = 0.016).

Conclusion: Surgical causes predominate in postoperative bleeding, though medical causes remain significant. Bleeding is associated with significant morbidity and mortality. Preventive surgical measures and multidisciplinary management are essential to improve outcomes