Konstantina Triantafillopoulou
St. Luke’s Hospital, Thessaloniki, Greece
Title: Perioperative Bleeding Management in Cardiac Surgery, the multidisciplinary approach
Biography
Biography: Konstantina Triantafillopoulou
Abstract
Introduction: Perioperative bleeding is common among patients in cardiac surgery. Major bleeding, transfusion and anemia have been characterized as the deadly triad of cardiac surgery. Patient blood management (PBM) in cardiac surgery contributes to the maintenance of perioperative haemostasis and the minimization of bleeding, which reduce blood transfusion requirements. PBM in cardiac surgery comprises of an interaction not only between the cardiothoracic surgeon, the anesthesiologist and the clinical perfusionist, but furthermore the cardiologist and hematologist.
Theoretical Orientation: This multidisciplinary approach following evidence-based guidelines can be the only accepted way to prevent any adverse outcomes. The methodology to identify and amend all factors related to increased risk of bleeding, transfusion and reoperation includes preoperative assessment, intraoperative techniques and postoperative management by all affiliated specialties. Advanced age, preoperative anemia, antiplatelet therapy and platelet dysfunction, use of NOACs, congenital and acquired coagulopathies, non-elective cardiac surgery, complex procedures and redo cardiac surgery, additional to individual comorbidities are only few of the risk factors. Risk scores, advanced surgical techniques, minimal procedures and PBM algorithms need to be addressed for the patient’s benefit.
Conclusion: Perioperative bleeding management in cardiac surgery comprises a multidisciplinary and multifactorial approach and consists of a sequence of separate strategies and interventions. It is a constant interaction between the cardiac surgeon, anesthesiologist, perfusionist, cardiologist, hematologist and intensivists, in addition to evidence-based guidelines, recommendations, algorithms, multicentric trials and ongoing research.