RESULTS OF APPLICATION OF THE PROTOCOL FOR THE PREVENTION OF BLEEDING IN CARDIAC SURGICAL PATIENTS WITH PATHOLOGY OF THE AORTIC VALVE AND AORTIC ROOT
Authors: Khubulava G. G. , Marchenko S. P. , Rzaeva E. Sh. , Naumov A. B. , Sazonov A. B. 
Published: December 2024

Purpose of the study: to evaluate the results of using a protocol for the prevention of bleeding in cardiac surgical patients with pathology of the aortic valve and aortic root to optimize tactics for preventing bleeding.Materials and methods: the first group included 185 cardiac surgical patients with pathology of the aortic valve and aortic root, who underwent surgery on the aortic valve, during the treatment of which a bleeding prevention protocol was applied. The second group consisted of 237 cardiac surgical patients with pathology of the aortic valve and aortic root who underwent surgery on the aortic valve, during whose treatment a bleeding prevention protocol was not used. Data were collected on the management tactics of the preoperative, intraoperative and postoperative periods, such as:– anamnestic data, results of echocardiographic examination, laboratory data: preoperative level of hemoglobin, fibrinogen;– intraoperative level of hemoglobin, fibrinogen, dose of transfused cryoprecipitate, thromboelastometry data, intraoperative blood loss;– drainage discharge during 1 day of the postoperative period, frequency of bleeding, resternotomy, and deaths.Study results: In the second group of patients, the number of cases of intraoperative hypofibrinogenemia was almost 5 times greater than in group 1; out of 237 patients, 62 (26.2%) had a critically low level of fibrinogen. Fibrinogen hemodilution coagulopathy (intraoperative hypofibrinogenemia) was associated with resternotomy: Х2 = 63.375, p = 0, df = 1, HR = 11.686, 95% CI: 5.61-24.33. Complications associated with bleeding were more common in the second group of patients – 44 (18,6%) cases out of 237 operated patients, Х2 = 10,6; р = 0,001, Х2Yates = 9,693; р = 0,002, RR = 2,453, 95% CI: 1,39-4,34. In the first group, there were only 14 (7,6%) cases of complications associated with bleeding out of 185 operated patients. Significant differences were also found in the frequency of resternotomies: in group 1 – 3 (1.6%) cases, in group 2 – 28 (11.8%) Х2 = 15,859; р = 0 (Х2Yates = 14,397, р = 0; р (F) = 0; RR = 7,286, 95% CI: 2,25-23,59). Of 185 operations in group 1, only 3 cases of resternotomy were observed, which corresponds to 1.6% of all patients in group 1. Upon repeated inspection of the surgical wound, surgical sources of bleeding were identified in all 3 cases. Of the 237 operations in group 2, there were 28 cases of repeated revision of the surgical wound. Of the 28 resternotomies, only in 15 cases a surgical source of bleeding was identified, therefore, the remaining 13 cases of bleeding occurred due to coagulopathy. In group 1, there were no cases of resternotomy performed due to hypocoagulable bleeding. A statistically significant association was found between preoperative anemia and resternotomy (x2, p = 0.039, RR = 2.03, 95% CI: 1-4).Conclusions:1) intraoperative hypofibrinogenemia increases the risk of resternotomy 11 times (x2 = 63.375, p = 0, df = 1, RR = 11.686, 95% CI: 5.61-24.33);2) preoperative anemia doubles the risk of resternotomy (p = 0,039, ОR = 2.03, 95% CI: 1-4);3) when using the bleeding prevention protocol, intraoperative hypofibrinogenemia occurs 5 times less often;4) when using the bleeding prevention protocol, complications associated with bleeding are 2.5 times less common: Х2 = 10,6; р = 0,001, Х2Yates = 9,693; р = 0,002, RR = 2,453, 95% CI: 1,39-4,34;5) when using a bleeding prevention protocol, the risk of resternotomy is reduced by 7 times: Х2 = 15,859; р = 0 (Х2Yates = 14,397, р = 0; р (F) = 0; RR = 7,286, 95% CI: 2,25-23,59).