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Thorac Cardiovasc Surg 2015; 63(01): 001
DOI: 10.1055/s-0034-1398744
Editorial
Georg Thieme Verlag KG Stuttgart · New York

Let It Bleed

Markus K. Heinemann
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Publication History

Publication Date:
16 January 2015 (online)

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One must have some nerve to start the year with an issue on complications, you may think. But here it is. You will read a lot about bleeding: why cardiac patients may bleed, what to do to avoid that, and something about liver function, because it's not always the drugs. And bleeding is not necessarily a complication. It is an unavoidable phenomenon in surgery and particularly so when you are apt to open and close blood vessels and heart chambers.

In an age of amazingly still increasing coronary stent implantations, many patients are referred to the cardiac surgeon under dual-antiplatelet therapy and worse. This may be because an urgent stent placement is indicated in an acute setting but in the context of three-vessel disease. It may also be because of insufficient stent treatment of multivessel disease. And there is still the occasional emergency case when percutaneous coronary intervention fails acutely and the clock is ticking. The likelihood of prolongated bleeding increases roughly in this order. And on top of all that atrial fibrillation patients are more and more anticoagulated with dabigatran, rivaroxaban, and the like.

As a consequence, surgeons and anesthesiologists must become acquainted with new substances and how to handle them appropriately. Fortunately, sophisticated tools have also been developed, which analyze coagulatory function in various ways and can be applied in the operating room or on the intensive care unit. As a consequence, a detailed diagnosis is often achieved quite rapidly and a suitable therapy can be started. This, in turn, should supersede the more traditional mass transfusion and undirected administration of coagulant factors.

Cardiac surgical intensive care in the setting of perioperative bleeding no longer means simply opening the fridge but differentiated diagnostics and targeted treatment. This is only one aspect of the ongoing evolution in this field. As has been reported here recently, “the attitude to understand that intensive care medicine is one of the key processes for patients in cardiac medicine has to be kept alive for the future.”[1]

In the context of bleeding it was finally impossible for the editor to avoid a mental connection to the seminal Rolling Stones album Let It Bleed of 1969. The song with the same title is one of the musically more ambitious efforts of the group in a somewhat uneven, very relaxed rhythm. “Sixth Stone” Ian Stewart holds it all together with his distinctive blues-rock piano chords. About the album lyrics the singer said: “Some people find some of the lyrics rude. Some of the lyrics ARE rude, actually.”[2] And the title song is by no means an exception. Toward the end the chorus goes like this:

Yeah, we all need someone we can bleed on.

And if you want it, baby, well you can bleed on me.

Yeah, we all need someone we can bleed on.

And if you want it, baby, why don'cha bleed on me? [3]

This is definitely not an invitation uttered by a cardiac surgeon. In the cultural scene and jargon of the late1960s London, however, the offer had its very own appeal.