Introduction
In cardiac surgery, effective bleeding control is crucial not only for procedural success but also for the patient’s recovery and long-term health. Hemorrhagic complications in open-heart surgeries pose significant risks, with incidence rates ranging from 5-9% – and severe cases potentially reaching 16%. Blood transfusions, though often necessary, come with risks like adverse effects and pathogen transmission. Patients requiring reoperation due to bleeding face a three-fold increase in mortality risk. While surgical causes account for 66% of postoperative bleeding, 33% are due to coagulation disorders [1].
As we delve into the methods used in cardiac surgery for bleeding control, it’s important to first consider the traditional approaches that have formed the foundation of surgical practice for decades. These methods, while effective in many cases, highlight the need for advancements like the SURGISPON® Patch when faced with more complex challenges.
Traditional Methods for Controlling Bleeding
Bleeding control in cardiac surgery traditionally involves both systemic and local approaches, each with its own advantages and limitations.
Systemic Approaches
- Blood Transfusions: administration of red blood cells, platelets, plasma, and cryoprecipitate to provide essential clotting factors and volume support.
- Pro-Coagulant Medications: including anti-fibrinolytics like tranexamic acid and aminocaproic acid are used to prevent the breakdown of clots.
- Recombinant Factor VII: a synthetic clotting factor that promotes coagulation, particularly in severe bleeding cases.
Local Approaches
- Direct Surgical Techniques
- Suturing: closes bleeding vessels or tissues manually, though it’s time-consuming and requires precision.
- Vessel Ligation: ties off blood vessels to control bleeding but can be challenging in deep or small vessels.
- Electrocautery: uses electric current to coagulate blood and seal vessels quickly, though it risks tissue damage.
- Haemostatic Maneuvers
- Digital Pressure Application: using fingers (digits) to apply pressure to bleeding sites, providing immediate control. This method is not sustainable for long durations and may be ineffective in severe cases.
- Warm Saline Irrigation: flushes the area to manage bleeding sources, offering temporary hemostasis.
- Bone wax: composed of beeswax and paraffin or vaseline, frequently applied to control hemorrhage from the sternum by mechanically blocking the bone’s spongiosa [2, 3].
While traditional methods provide a strong foundation, they are not always sufficient, especially in cases involving complex coagulation disorders or extensive bleeding. To address these limitations, topical haemostatic agents have been developed, offering more targeted and effective solutions in challenging surgical scenarios.
Haemostatic Agents and Their Use in Cardiac Surgery
The development and use of haemostatic agents have significantly advanced the ability to control bleeding in cardiac surgery. These agents can be categorized based on their composition and mechanism of action.
Benefits of SURGISPON® Patch
- Superior haemostasis: forms a stable clot, reducing the risk of excessive bleeding and minimizing blood transfusion needs.
- Advanced design: the patch is thin and adheres firmly to the bleeding suture site, sealing it to promote faster healing. Its design creates a protective layer that keeps the stitches stable, minimizing movement and preventing displacement, which improves suture retention. The patch’s minimal thickness prevents significant swelling and avoids putting pressure on nearby tissues.
- Ease of handling: requires no rinsing before procedures, can easily be trimmed to the desired size, and accommodates cardiovascular anatomy.
- Reliable performance: improved suture retention, low thrombogenicity, and resistance to aneurysmal dilation
- Durability: non-fraying property ensures reliable performance during surgery.
