Packing the chest –harbinger of death or a useful hemostatic manoeuvre  in aortic surgery – a ma...
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American Association for Thoracic Surgery Aortic Symposium 2010, New York PowerPoint PPT Presentation


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Packing the chest –harbinger of death or a useful hemostatic manoeuvre in aortic surgery – a matched case-control study.

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American Association for Thoracic Surgery Aortic Symposium 2010, New York

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American association for thoracic surgery aortic symposium 2010 new york

Packing the chest –harbinger of death or a useful hemostatic manoeuvre in aortic surgery – a matched case-control study.

Ishtiaq A Rahman,  Mahmoud Loubani, Aaron Ranasinghe, Reena Panchal, Viv Barnett, Timothy R Graham, Ian C Wilson, Domenico Pagano, Steve Rooney, Jorge G Mascaro,  Robert S Bonser,

American Association for Thoracic Surgery

Aortic Symposium 2010, New York


American association for thoracic surgery aortic symposium 2010 new york

Objectives

Packing the field with swabs may be the last resort for persistent intra-operative bleeding.

We aimed to compare outcomes in such cases versus matched controls.


American association for thoracic surgery aortic symposium 2010 new york

Methods

Patients undergoing aortic surgery via median sternotomy identified (1997-2009).

Patients requiring mediastinal packing individually matched via operative database for controls.

Matching performed by investigators blinded to outcome for operation type, urgency, age, gender, operative priority, number of previous operations, era of operation, vascular pathology.


American association for thoracic surgery aortic symposium 2010 new york

Results

Aortic procedures via median sternotomy

n=790

Patients requiring packing

n=49

Non-packed Controls

n=49


American association for thoracic surgery aortic symposium 2010 new york

Results


American association for thoracic surgery aortic symposium 2010 new york

Results


American association for thoracic surgery aortic symposium 2010 new york

Results – Transfusions in Theatre


American association for thoracic surgery aortic symposium 2010 new york

Results – Transfusions on ITU


American association for thoracic surgery aortic symposium 2010 new york

Results


American association for thoracic surgery aortic symposium 2010 new york

Results


American association for thoracic surgery aortic symposium 2010 new york

Results – long term survival

p=0.192


American association for thoracic surgery aortic symposium 2010 new york

Conclusion

Packing is a reasonable treatment option when primary haemostasis cannot be achieved.

Similar survival to matched controls, without an increase in infective complications, but is associated with an increased transfusion and ventilation time.

It remains an important bail-out technique to secure haemostasis in this high risk population.


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