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).