Biosurgical Hemostasis in Thoracic and Cardiac Surgery: A Practical Approach

Patients undergoing cardiothoracic surgery, especially open cardiac procedures requiring cardiopulmonary bypass, are exposed to several alterations in primary and secondary hemostasis. These derangements are associated with increased microvascular bleeding that is refractory to conventional surgical maneuvers aimed at achieving hemostasis. This poses a technical problem for the surgeon and exposes the patient to increased morbidity from uncontrolled bleeding and any associated transfusion of blood products. Use of biosurgical hemostatic agents, specifically in patients undergoing cardiac surgery, have been shown to be safe and effective in reducing time to hemostasis, decreasing transfusion of blood products, and improving patient outcomes. Despite their merits, selection of a topical hemostat is frequently based on anecdotal experience and limited knowledge of the available agents. The prepared surgeon is familiar with these agents and can anticipate opportunities for their deployment in the setting of coagulopathy.