Chest reexploration in the intensive care unit after cardiac surgery: A safe alternative to returning to the operating theater

Background. The aim of this study was to determine the outcome of patients who had chest reexploration in the intensive care unit (ICU) for bleeding or cardiovascular instability after heart surgery. Methods. This was a retrospective analysis of medical records of patients who had a chest reexploration in the ICU for bleeding or possible cardiac tamponade over a 9-year period (1991 to 2000), at the Cardiothoracic Centre of Manchester Royal Infirmary, England. Results. Between 1991 and 2000, 240 patients (3.4% of the total heart operations) who fitted the above criteria were identified. Two hundred and seven (86%) were reexplored for bleeding, 22 (9%) for possible tamponade, and 11 (5%) for both. Ninety-five percent were reexplored within 24 hours (median, 5 to 6 hours). Two hundred and twenty-six patients were found to have bleeding on reexploration. Of these, 125 (55%) were found to have focal bleeding, 74 (33%) diffuse bleeding, and 11 (5%) both. Two hundred and twelve (88%) had their chest closed, 25 (12%) packed, and 13 (10%) had further chest openings while in ICU. Sixteen (6.7%) of the patients died. Seven (2.9%) had sternal wound infection. For the survivors, ICU stay ranged from 1 to 60 days (median, 1) and their hospital stay ranged from 2 to 90 days (median, 8). Conclusions. Chest reexploration in ICU for bleeding or tamponade after heart surgery can be a safe alternative to return to the operating theater.