With Retained Blood, Bleeding Begets More Bleeding after Cardiac Surgery

All patients who have surgery have some degree of bleeding in the mediastinum in the immediate postoperative period, called Shed Mediastinal Blood (SMB). Usually this is a microvascular oozing rather than dramatic surgical bleeding. SMB must be cleared by chest tubes placed to evacuate it until the bleeding stops, usually in the first 12 hours after surgery.1 Any impairment in the evacuation of SMB by chest tubes can result in retained blood around the heart.2 Numerous studies have documented that SMB is high in inflammatory mediators, suggesting that when the blood sits in this space, neutrophils are attracted and oxidative stress ensues.3 One biomarker that has been documented acutely in the postoperative

Level 1A Evidence that Reducing Retained Blood Prevents POAF and Effusions After Cardiac Surgery

The Journal of Thoracic and Cardiovascular Surgery published a recent manuscript entitled “Systematic review and meta-analysis of randomized controlled trials assessing safety and efficacy of posterior pericardial drainage in patients undergoing heart surgery”. Nineteen randomized controlled trials enrolled 3,425 patients who were analyzed to determine if efforts to reduce retained blood around the heart after heart surgery might reduce postoperative atrial fibrillation (POAF), retained blood syndrome (pericardial effusions, tamponade, pericardial effusions), hospital resource utilization, and death.1 The focus was the addition of the surgical technique known as “posterior pericardiotomy,” where the surgeon creates a long incision in the posterior pericardium to drain any retained blood into the pleural space, thereby shunting