Cardiopulmonary Bypass Hemorrhage: A Surgeon's Point of View

Despite shorter operating time, more experience and improved equipment, the introduction of anticoagulants and the mechanical trauma (inherent in cardiopulmonary bypass) acting independently or in combination may lead to excessive bleeding [11]. The question, under these circumstances, concerns the methods and technics [7, 13] which can be employed to minimize bleeding while quickly, and deliberately identifying and treating [17] those situations of a nonsurgical nature so as to avoid unnecessary reoperation, conserve blood, and reduce transfusion reactions. In essence, these bleeding problems are caused by an inadequate surgical closure or result from an increased utilization or destruction of hemostatic factors. Additional causes relate to the presence of circulating anticoagulants or a reduction in hemostatic factors due to underproduction or dilution of transfused blood as well, as to the disease process under treatment or to an adverse drug response. The result, in any instance, is excessive bleeding, manifested as (1) an open blood vessel, (2) an excess of circulating fibrin(ogen) split products or fibrinolysis, (3) an excessive heparin or protamine effect, (4) an intrinsic or extrinsic factor defect, or (5) any combination of the above findings.