Share This Article:

High Altitude: A Possible Reason for Postoperative Bleeding after Coronary Artery Bypass Graft Operations

Abstract Full-Text HTML XML Download Download as PDF (Size:261KB) PP. 79-86
DOI: 10.4236/wjcd.2015.54011    2,094 Downloads   2,544 Views  

ABSTRACT

Background: This study evaluated the possible hypothesis that high altitude might be a reason of excessive postoperative drainage after coronary artery bypass graft operations (CABG). Methods: 212 patients were operated by the same surgical team and included to the study with retrospective data scan on postoperative bleeding after elective CABG with cardiopulmonary bypass (CPB). Study was derived from two different altitude centers: Group A patients (n = 107) from the center at an altitude of 1985 meters and Group B patients (n = 105) from the center in approximately sea level with 150 meters altitude. Multiple preoperative, intraoperative and postoperative characteristics with postoperative bleeding amounts were reviewed and calculated to determine a result through the aim of our study. Results: Preoperative, operative and intraoperative parameters for both groups were almost identical. Statistically significance occurred on intensive care unit treatment period, total hospitalization days, usage of erythrocyte suspension and fresh frozen plasma among postoperative periods on behalf of Group B. Parameters such as CABG numbers, Cross clamp and CPB time were not significant. High altitude patients were considered to be with a higher outcome in preoperative hematocrit (Htc) levels which did not occur in the study group. Htc levels presented a slight elevation for Group A as in the preoperative values but a statistically significance was not calculated. Postoperative bleeding volumes and calculated mean values were statistically significantly different among both groups in days of 1, 2 and 3. Reoperations for hemorrhage occurred in 9 cases (8.4%) in Group A and 4 cases (3.8%) in Group B. Conclusions: We want to attract attention to the relation between high altitude and postoperative bleeding after CABG surgery. But yet uncertain and unidentified physiological and biochemical conditions can be a reason as an uncontrollable perioperative factor in this patients. Operation at high altitude can be a reason for postoperative excessively bleeding.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Abud, B. , Talay, S. , Karaarslan, K. , Turhan, S. , Ünal, C. and Kubat, E. (2015) High Altitude: A Possible Reason for Postoperative Bleeding after Coronary Artery Bypass Graft Operations. World Journal of Cardiovascular Diseases, 5, 79-86. doi: 10.4236/wjcd.2015.54011.

References

[1] Frankel, T.L., Stamou, S.C., Lowery, R.C., Kapetanakis, E.I., Hill, P.C., Haile, E. and Corso, P.J. (2005) Risk Factors for Hemorrhage-Related Reexploration and Blood Transfusion after Conventional versus Coronary Revascularization without Cardiopulmonary Bypass. European Journal Cardio-Thoracic Surgery, 27, 494-500.
http://dx.doi.org/10.1016/j.ejcts.2004.11.021
[2] Wans, S., Leclerc, J.L. and Vincent, J.L. (1997) Inflammatory Response to Cardiopulmonary Bypass: Mechanisms Involved and Possible Therapeutic Strategies. Chest, 112, 676-692.
http://dx.doi.org/10.1378/chest.112.3.676
[3] Fitzgerald, D.C., Holmes, S.D., St Onge, J.R., Ioanou, C., Martin, L.M. and Ad, N. (2015) Systemic Inflammatory Response during Cardiac Surgery: A Pilot Study. Innovations, 10, 125-132.
http://dx.doi.org/10.1097/IMI.0000000000000123
[4] Kirklin, J.K. (1991) Prospects for Understanding and Eliminating the Deleterious Effects of Cardiopulmonary Bypass. The Annals of Thoracic Surgery, 51, 812-813.
http://dx.doi.org/10.1016/0003-4975(91)90134-C
[5] Yank, V., Tuohy, C.V., Logan, A.C., Bravata, D.M., Staudenmayer, K., Eisenhut, R., et al. (2011) Systematic Review: Benefits and Harms of In-Hospital Use of Recombinant Factor VIIa for Off-Label Indications. Annals of Internal Medicine, 154, 529-540.
http://dx.doi.org/10.7326/0003-4819-154-8-201104190-00004
[6] Brown, C., Joshi, B., Faraday, N., Shah, A., Yuh, D., Rade, J.J., et al. (2011) Emergency Cardiac Surgery in Patients with Acute Coronary Syndromes: A Review of the Evidence and Perioperative Implications of Medical and Mechanical Therapeutics. Anesthesia & Analgesia, 112, 777-799.
http://dx.doi.org/10.1213/ANE.0b013e31820e7e4f
[7] Clark, K.B., Kon, N.D., Hammon Jr., J.W., MacGregor, D.A., Kincaid, E.H. and Reichert, M.G. (2013) Factor IX Complex for the Treatment of Severe Bleeding after Cardiac Surgery. Journal of Cardiovascular Pharmacology, 62, 67- 71.
http://dx.doi.org/10.1097/FJC.0b013e318290922f
[8] Uns-Worth-White, M.J., Herriot, A., Valencia, O., Poloniecki, J., Smith, E.E.J., Murday, A.J., Parker, J. and Treasure, T. (1995) Resternotomy for Bleeding after Cardiac Operations: A Marker for Increased Morbidity and Mortality. The Annals of Thoracic Surgery, 59, 664-667.
http://dx.doi.org/10.1016/0003-4975(94)00995-3
[9] Biancari, F., Airaksinen, K.E.J. and Lip, G.Y. (2012) Benefits and Risks of Using Clopidogrel before Coronary Artery Bypass Surgery: Systematic Review and Meta-Analysis of Randomized Trials and Observational Studies. The Journal of Thoracic and Cardiovascular Surgery, 143, 665-675.
http://dx.doi.org/10.1016/j.jtcvs.2011.01.069
[10] Koster, A. and Schirmer, U. (2010) Re-Evaluation of the Role of Antifibrinolytic Therapy with Lysine Analogs during Cardiac Surgery in the Post Aprotinin Era. Current Opinion in Anesthesiology, 24, 92-97.
http://dx.doi.org/10.1097/ACO.0b013e32833ff3eb
[11] Karthik, S., Grayson, A.D., McCarron, E.E., Pullan, D.M. and Desmond, M.J. (2004) Reexploration for Bleeding after Coronary Artery Bypass Surgery: Risk Factors, Outcomes, and the Effect of Time Delay. Annals of Thoracic Surgery, 78, 527-534.
http://dx.doi.org/10.1016/j.athoracsur.2004.02.088
[12] Ranucci, M., Bozzetti, G., Ditta, A., Cotza, M., Carboni, G. and Ballotta, A. (2008) Surgical Reexploration after Cardiac Operations: Why a Worse Outcome? Annals of Thoracic Surgery, 86, 1557-1562.
http://dx.doi.org/10.1016/j.athoracsur.2008.07.114
[13] Dacey, J.L., Munoz, J.J., Baribeaou, Y.R., Johnson, E.R., Lahey, S.J., Leavitt, B.J., Quinn, R.D., Nugent, W.C., Birkmeyer, J.D. and O’connor, G.T. (1998) Reexploration for Hemorrhage Following Coronary Artery Bypass Grafting. Archives of Surgery, 133, 442-447.
http://dx.doi.org/10.1001/archsurg.133.4.442
[14] Gay, W.A. (1990) Aspirin, Blood Loss and Transfusion. Annals of Thoracic Surgery, 50, 345.
http://dx.doi.org/10.1016/0003-4975(90)90471-H
[15] Levine, B.D. and Stray-Gundersen, J. (1991) Living High-Training Low: Effect of Moderate-Altitude Acclimatization with Low-Altitude Training on Performance. Journal of Applied Physiology, 83, 102-112.
[16] Gore, C.J. and Hopkins, W.G. (1999) Counterpoint: Possitive Effects of Intermittent Hypoxia on Exercise Performance Are Not Mediated Primarily by Augmented Red Cell Volume. Journal of Applied Physiology, 5, 2055-2057.

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.