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Re-exploration after off pump coronary artery bypass grafting: incidence, risk factors and impact of timing
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  • Kartik Patel,
  • Sudhir Adalti,
  • Shreyas Runwal,
  • Rahul Singh,
  • Chandrasekaran Ananthanarayanan,
  • Chirag Doshi,
  • Himani Pandya
Kartik Patel
U.N.Mehta Institute of Cardiology and Research Center
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Sudhir Adalti
U.N.Mehta Institute of Cardiology and Research Center
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Shreyas Runwal
U.N.Mehta Institute of Cardiology and Research Center
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Rahul Singh
U.N.Mehta Institute of Cardiology and Research Center
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Chandrasekaran Ananthanarayanan
U. N. Mehta Institute of Cardiology and Research Center
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Chirag Doshi
U.N.Mehta Institute of Cardiology and Research Center
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Himani Pandya
U.N.Mehta Institute of Cardiology and Research Center
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Abstract

Objective: Re-exploration after cardiac surgery still remained a troublesome complication. There is still scarcity of data about the effect of re-exploration after off-pump coronary arterial bypass grafting (OPCABG). We here represent our experience of re-exploration following OPCABG. Method: Total 5990 OPCABG were performed at our center, out-off these 132 (2.2%) patients were re-explored in the OR and were included in this study. The medical records of these patients were retrospectively reviewed. Results: The most common cause of re-exploration was bleeding (83.3%) and most common site of bleeding was from graft/anastomosis (53.8%). Mean time to re-exploration was 9.75±8.65 hours. 30-day mortality was 1.41%.On univariate and multiple regression analysis, emergency surgery, preoperative low platelet count, and number of grafts were found to be an independent risk factor for re-exploration. On multiple regression, emergency surgery, euroscoreII, low platelet count, low ejection fraction, re-exploration, time to re-exploration, blood products used, high post-op serum creatinine and bilirubin, were found to be an independent factor (p<0.001) for mortality. On receiver-operating characteristic analysis, optimum cut off for time to re-exploration was 14 hours with sensitivity 81.3%, specificity of 80% and area under curve of 0.798. Patients who re-explored late (>14 hour) had significantly high mortality (30.55%vs7.3%) and morbidity. Conclusion: Delaying the re-exploration is associated with three-fold increase in mortality and morbidity. So strategy of minimizing the incidence of re-exploration like use of minimally invasive surgery and early re-exploration with judicial use of products should be use to improve outcome after re-exploration following off-pump CABG.

Peer review status:Published

23 Jun 2020Submitted to Journal of Cardiac Surgery
23 Jun 2020Submission Checks Completed
23 Jun 2020Assigned to Editor
23 Jun 2020Reviewer(s) Assigned
29 Jun 2020Review(s) Completed, Editorial Evaluation Pending
29 Jun 2020Editorial Decision: Revise Minor
25 Jul 20201st Revision Received
28 Jul 2020Submission Checks Completed
28 Jul 2020Assigned to Editor
01 Aug 2020Reviewer(s) Assigned
13 Aug 2020Review(s) Completed, Editorial Evaluation Pending
18 Aug 2020Editorial Decision: Accept
16 Sep 2020Published in Journal of Cardiac Surgery. 10.1111/jocs.14986