Multiple re-exploration due to excessive bleeding due to coagulopathy after aortic valve replacement in patients with chronic asymptomatic hepatitis B infection: A case report

Background: Postoperative bleeding following cardiac surgery represents a recognized and significant complication, particularly in patients with asymptomatic hepatitis B infection who have undergone open-heart procedures with a cardiopulmonary bypass machine (CPB). Patients requiring re-exploration due to bleeding face elevated mortality risks due to detrimental factors associated with the procedure, such as bleeding, transfusions, hypoperfusion resulting from cardiac tamponade or blood loss, multiple organ ischemia, and organ failure. The aim of this article is to discuss perioperative preparations specific to cases of patients with chronic hepatitis B undergoing open-heart surgery. Case Presentation: This case study revolves around a 53-year-old Asian male who had been slated for aortic valve replacement. Transthoracic echocardiography (TTE) uncovered severe aortic regurgitation with vegetation at the non-coronary cusp (NCC) and right coronary cusp (RCC), accompanied by chamber dilatation. The patient was under Tenofovir therapy for his chronic yet asymptomatic hepatitis B infection. The surgical procedure utilized a cardiopulmonary bypass machine (CPB), but multiple re-explorations were necessitated due to excessive bleeding attributed to post-surgery coagulopathy. Conclusion: Postoperative bleeding following cardiac surgery represents a widely recognized and serious complication, particularly in patients with asymptomatic hepatitis B infection who have undergone open-heart procedures with CPB. CPB has been extensively documented to stimulate the generation and release of various vasoactive substances and cytotoxic mediators, disrupting "rebalanced hemostasis" and leading to coagulopathy.