In our center, cardiac operations were performed under general anesthesia (fentanyl 35μg / kg, pancuronium 0.1mg / kg) with positive pressure ventilation. Median sternotomy was performed in all patients and aorto-right atrial cannulation method was preferred. Before switching to cardiopulmonary bypass (CPB), 3 mg / kg heparin was administered to the patients and additional heparin dose was given if necessary, to keep activated clotting time (ACT)> 480. When switching to CPB, antegrade or antegrade + retrograde crystalloid solutions were used as prime solutions according to the patient’s body mass index. Systemic hypothermia was achieved by cooling the patient to 32°C. During the surgical procedure, blood accumulated in the thoracic cavity and pericardial area was collected in the reservoir and re-infused to the patient. However, unfortunately, methods such as cell saver could not be used. The cardiac operation was completed, and bleeding was controlled with protamine sulphate (3.1 mg / kg) administration to keep ACT <120 s during weaning from CPB.
The left hemithorax was opened with left pleural incision in all patients. The right hemithorax may have been opened in some patients, however, bleeding was monitored in the intensive care unit with 32 French drains placed in all hemithoracic cavities and 36 French drains placed in the mediastinum. After the sternum was closed with sternal wires, the subcutaneous and skin tissues were closed, and the intubated patient was transported to the intensive care unit. In our center, the surgical team is responsible for the intensive care of the patients. The patients were extubated in the intensive care unit based on the extubation criteria. According to the institution’s protocol, patients with high volumes of drainage and/or hemodynamic instability were not extubated. In cases where the drainage was voluminous enough to impair hemodynamics, the patients were re-explored for bleeding revision. Fresh frozen plasma (FFP) was transfused to the patients if the central venous pressure was <8, or when the patient had more drainage than expected. Colloid solutions can be used instead of FFP, but FFP is primarily used due to clinical preference. Erythrocyte transfusion was performed when Hg <8 gm%. Platelet suspensions were administered according to the platelet count in the hemogram obtained postoperatively as the patient entered the intensive care unit.
Descriptive parameters of the scoring systems used in the study are shown in Table (Table 1).