Abstract:

Complications in the early postoperative period after cardiac surgery using 
cardiopulmonary bypass (CPB) remain a leading cause of morbidity and mortality. Timely 
diagnosis and appropriate management are essential for improving survival, yet a standardized 
clinical approach is still lacking. The aim of the study is to present and clinically evaluate a newly 
developed management algorithm for patients with severe early postoperative complications 
following cardiac surgery with CPB. Materials and Methods: A single-center retrospective analysis 
was conducted on 154 patients who underwent cardiac surgery with CPB between 2013 and 2022 
and required reoperation within the first 30 days. A multidisciplinary management algorithm was 
developed, based on clinical, hemodynamic, and laboratory criteria, with the option to initiate 
mechanical circulatory support. The indications for reoperation, time to intervention, ECMO use, 
and clinical outcomes were analyzed. Results: The most common indications for reoperation were 
persistent bleeding (43.5%), cardiac tamponade (25.9%), and infectious complications (6.5%). 
Overall mortality was 12.3%, while in patients requiring ECMO it exceeded 80%. Implementation 
of an early identification strategy for critical conditions, including re-exploration within the first 24 
hours, was associated with significantly lower mortality. Conclusion: The proposed clinical 
management algorithm for early postoperative complications in cardiac surgery patients with CPB 
demonstrates practical effectiveness by structuring the diagnostic and therapeutic process, 
reducing the time to intervention, and optimizing treatment outcomes. Validation through 
prospective multicenter studies is recommended.

 
Keywords: cardiac surgery; cardiopulmonary bypass; early complications; reoperation; management 
algorithm; ECMO; clinical assessment.

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