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González-Suárez S, Barbosa CS, García-Navia JT. Superior Vena Cava Syndrome after Epicardial Pacing Wires Removal. Ann Card Anaesth 2024; 27:372-374. [PMID: 39206767 DOI: 10.4103/aca.aca_36_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/08/2024] [Indexed: 09/04/2024] Open
Abstract
ABSTRACT Although most superior vena cava (SVC) syndromes are due to intrathoracic malignancies, some are iatrogenic, such as those following the intravenous implantation of pacemaker wires. To date, the occurrence of this syndrome after epicardial pacemaker removal has not been described. The initial auricular laceration after removal can be complicated by the administration of anticoagulant and antiplatelet drugs, forming a hematoma that compresses the SVC cranially. Therefore, standardized practice may be necessary in these patients to address anticoagulant and antiplatelet therapy, perform serial echocardiography, and pay attention to underlying symptoms, which may be insidious and delayed.
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Affiliation(s)
- Susana González-Suárez
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Anesthesiology and Intensive Care, University Hospital Vall d'Hebron, Barcelona, Spain
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2
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Wu JJ, Jiang J, Ye J, Turgeon RD, Wang EH. Direct Oral Anticoagulant Use Early After Cardiac Surgery: A Retrospective Cohort Study. CJC Open 2024; 6:65-71. [PMID: 38585681 PMCID: PMC10994972 DOI: 10.1016/j.cjco.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/19/2023] [Indexed: 04/09/2024] Open
Abstract
Background There is limited literature guiding the prescribing of direct oral anticoagulants (DOACs) early after cardiac surgery as this population has been excluded from landmark randomized controlled trials. This study aims to determine the rate of in-hospital DOAC use compared with warfarin early after cardiac surgery, evaluate factors associated with DOAC use, determine difference in postoperative length of stay, and characterize bleeding events. Methods A retrospective cohort study was conducted in adult patients with indications for anticoagulation and receiving either a DOAC or warfarin after cardiac surgery during their index hospitalization. Patients were excluded if they had any contraindications to DOAC use. The primary outcome was the proportion of patients discharged on a DOAC compared with warfarin. Results Of included 210 patients, 30% received DOACs and 70% received warfarin on discharge. The most common DOAC used was apixaban (74.6%), and median postoperative day of initiation was 5 days. Patients receiving DOACs were older (70.8 vs 68.0 years), had less valvular heart disease (38.1% vs 63.9%), were more likely to be on DOACs preoperatively (50.8% vs 31.3%), and were more likely to have undergone coronary artery bypass graft alone (54.0% vs 24.5%) compared with those on warfarin. Postoperative length of stay (7 vs 9 days; P = 0.59) and in-hospital bleeding (1.6% vs 2.0%; P = 1.00) did not differ between DOAC and warfarin groups. Conclusions At a quaternary referral centre for cardiac surgery, DOACs were used in approximately one-third of patients with an indication for anticoagulation early after cardiac surgery.
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Affiliation(s)
- Jung-Jin Wu
- Department of Pharmacy, Ridge Meadows Hospital, and Faculty of Pharmaceutical Sciences, Maple Ridge, British Columbia, Canada
| | - Jessie Jiang
- Department of Pharmacy, Vancouver General Hospital, and Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada
| | - Jian Ye
- Division of Cardiac Surgery, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ricky D. Turgeon
- Department of Pharmacy, St. Paul’s Hospital, and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erica H.Z. Wang
- Department of Pharmacy, St. Paul’s Hospital, and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Efrimescu CI, Walsh DM, Chughtai JZ, Wall TP. Preoperative initiation of peripheral veno-arterial extracorporeal membrane oxygenation for a complex case of cardiac tamponade. BMJ Case Rep 2023; 16:e253913. [PMID: 37751972 PMCID: PMC10533732 DOI: 10.1136/bcr-2022-253913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
In this case report, we present an alternative approach to the anaesthetic management of patients presenting with delayed postoperative cardiac tamponade physiology. Given that pericardiocentesis was deemed unsafe, and a protracted surgical dissection was anticipated, peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support was established prior to induction of anaesthesia to prevent catastrophic circulatory failure. To the best of our knowledge, this is the first reported case of planned preoperative commencement of peripheral VA-ECMO in a complex case of cardiac tamponade. We discuss the challenges associated with this case and the process for selecting this strategy. We also describe the role of transoesophageal echocardiography in planning the surgical approach. This report is completed by a discussion on the topic of delayed postoperative pericardial effusion and tamponade.
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Affiliation(s)
- Catalin Iulian Efrimescu
- Department of Anesthesiology & Perioperative Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Don M Walsh
- Department of Anesthesiology & Perioperative Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jehan Zeb Chughtai
- Department of Cardiothoracic Surgery and Heart and Lung Transplantation, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Thomas P Wall
- Department of Anesthesiology & Perioperative Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
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Hoit BD. Pericardial Effusion and Cardiac Tamponade Pathophysiology and New Approaches to Treatment. Curr Cardiol Rep 2023; 25:1003-1014. [PMID: 37515704 DOI: 10.1007/s11886-023-01920-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE OF REVIEW The objective of this manuscript is to examine up-to-date approaches to the diagnosis and treatment of pericardial effusions and cardiac tamponade. RECENT FINDINGS Recent recommendations from the American Society of Echocardiography and the European Society of Cardiology have improved our management of the patient with pericardial effusion and cardiac tamponade, but significant knowledge gaps remain. Novel diagnostic and triage strategies have been suggested, and recent information have improved our facility to assess the presence and size of a pericardial effusion, assess its hemodynamic impact, and determine its cause. Despite these recent findings, there is a scarcity of evidence-based data to direct the management of pericardial effusion and cardiac tamponade. While the first-line function of echocardiography in managing these disorders is undisputed, there are increasingly niche functions for multimodality imaging.
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Affiliation(s)
- Brian D Hoit
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
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Abdelaziz A, Hafez AH, Elaraby A, Roshdy MR, Abdelaziz M, Eltobgy MA, Elsayed H, El-Samahy M, Elbehbeh NA, Philip KG, Abdelaty AM, Rizk MA, Al-Tawil M, AboElfarh HE, Ramadan A, Ghaith HS, Wahsh EA, Abdelazeem B, Fayed B. Posterior pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: a systematic review and meta-analysis of 25 randomised controlled trials. EUROINTERVENTION 2023; 19:e305-e317. [PMID: 36927670 PMCID: PMC10336425 DOI: 10.4244/eij-d-22-00948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/31/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) associated with postoperative pericardial effusion is the most commonly reported adverse event after cardiac surgery. AIMS We aimed to determine the role of posterior pericardiotomy in preventing postoperative AF (POAF). METHODS We searched PubMed, Scopus, Web of Science, Ovid, and EBSCO from inception until 30 June 2022. We included randomised clinical trials (RCTs) that compared posterior pericardiotomy (PP) versus control (no PP) in patients undergoing cardiac surgery. The primary endpoint was the incidence of POAF after cardiac surgery. The secondary endpoints were supraventricular arrhythmias, early/late pericardial effusion, pericardial tamponade, pleural effusion, length of hospital/intensive care unit stay, intra-aortic balloon pump use, revision surgery for bleeding, and mortality. RESULTS Twenty-five RCTs comprising 4,467 patients were included in this systematic review and meta-analysis. The overall incidence rate of POAF was 11.7% in the PP group compared with 23.67% in the no PP or control group, with a significant decrease in the risk of POAF following PP (odds ratio [OR] 0.49, 95% confidence interval [CI]: 0.38-0.61). Compared with the control group, the risk of supraventricular tachycardia (OR 0.66, 95% CI: 0.43-0.89), early pericardial effusion (OR 0.32, 95% CI: 0.22-0.46), late pericardial effusion (OR 0.15, 95% CI: 0.09-0.25), and pericardiac tamponade (OR 0.18, 95% CI: 0.10-0.33) were lower in the PP group. CONCLUSIONS PP is an effective intervention for reducing the risk of POAF after cardiac surgery. Also, PP is economically efficient in terms of decreasing the length of hospital stay.
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Affiliation(s)
- Ahmed Abdelaziz
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdelrahman H Hafez
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Elaraby
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Merna Raafat Roshdy
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mohamed Abdelaziz
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Moemen A Eltobgy
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Hanaa Elsayed
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed El-Samahy
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nada Abdallah Elbehbeh
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Kerollos George Philip
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Arwa Mohamed Abdelaty
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Marwa Abdelazim Rizk
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Al-Tawil
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Hadeer Elsaeed AboElfarh
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Mansoura Manchester Programme for Medical Education, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Alaa Ramadan
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, South Valley University, Qena Governorate, Egypt
| | - Hazem S Ghaith
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Engy A Wahsh
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Department of Clinical Pharmacy, Faculty of Pharmacy, October 6 University, Giza, Egypt
| | - Basel Abdelazeem
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- McLaren Flint Hospital, Flint, MI, USA
- Michigan State University, East Lansing, MI, USA
| | - Badr Fayed
- Cardiothoracic Surgery Department, Faculty of Medicine, Port Said University, Port Said, Egypt
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Schmidt T, Malik A, Pislaru S, Sinak L. Don't Tear My Heart: Sternal Wire Pericardial Injury After Aortic Valve Replacement. CASE (PHILADELPHIA, PA.) 2023; 7:278-282. [PMID: 37546360 PMCID: PMC10403635 DOI: 10.1016/j.case.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
•TTE is a valuable cardiac imaging tool given its availability. •TTE can be used for the evaluation of cardiothoracic surgical complications. •Imaging modalities aid in supplementing information in postoperative patients. •Sternal wire fracture may cause a cardiac laceration.
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Affiliation(s)
- Tyler Schmidt
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Awais Malik
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Sorin Pislaru
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Lawrence Sinak
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
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van Dinter S, Li W, Wollersheim L, Rodwell L, van Royen N, Dieker HJ, Verhagen A. Variations in current clinical practice of postoperative pericardial effusion: a questionnaire study. Open Heart 2023; 10:openhrt-2023-002271. [PMID: 37094990 PMCID: PMC10152046 DOI: 10.1136/openhrt-2023-002271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 03/31/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVE Postoperative pericardial effusion (PPE) occurs frequently after cardiac surgery, potentially leading to life-threatening cardiac tamponade. Specific treatment guidelines are currently lacking, possibly leading to variations in clinical practice. Our goal was to assess clinical PPE management and evaluate variation between centres and clinicians. METHODS A nationwide survey was sent to all interventional cardiologists and cardiothoracic surgeons in the Netherlands, regarding their preferred diagnostic and treatment modality of PPE. Clinical preferences were explored utilising four patient scenarios, each with a high/low echocardiographic and clinical suspicion of cardiac tamponade. Scenarios were also stratified by three PPE sizes (<1 cm, 1-2 cm, >2 cm). RESULTS In total, 46/140 interventional cardiologists and 48/120 cardiothoracic surgeons responded (27/31 contacted centres). Cardiologists favoured routine postoperative echocardiography in all patients (44%), whereas cardiothoracic surgeons preferred routine imaging after specific procedures, especially mitral (85%) and tricuspid (79%) valve surgery. Overall, pericardiocentesis (83%) was preferred over surgical evacuation (17%). Regarding all patient scenarios, cardiothoracic surgeons significantly preferred evacuation compared with cardiologists (51% vs 37%, p<0.001). This was also observed with cardiologists employed in surgical centres compared with non-surgical centres (43% vs 31%, p=0.02). Inter-rater analysis varied from poor to near-excellent (к 0.22-0.67), suggesting varying PPE treatment preferences within one centre. CONCLUSION There is significant variation in the preferred management of PPE between hospitals and clinicians, even within the same centre, possibly due to the lack of specific guidelines. Therefore, robust results of a systematic approach to PPE diagnosis and treatment are needed to formulate evidence-based recommendations and optimise patient outcome.
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Affiliation(s)
| | - Wilson Li
- Cardiothoracic Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Laurens Wollersheim
- Cardiothoracic Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Laura Rodwell
- Department for Health Evidence, Radboudumc, Nijmegen, The Netherlands
| | | | | | - Ad Verhagen
- Cardiothoracic Surgery, Radboudumc, Nijmegen, The Netherlands
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Kaemmerer AS, Alkhalaileh K, Suleiman MN, Kopp M, Hauer C, May MS, Uder M, Weyand M, Harig F. Pericardial tamponade, a diagnostic chameleon: from the historical perspectives to contemporary management. J Cardiothorac Surg 2023; 18:60. [PMID: 36739433 PMCID: PMC9898697 DOI: 10.1186/s13019-023-02174-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/28/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pericardial tamponade (PT) early after cardiac surgery is a challenging clinical entity, not infrequently misrecognized and often only detected late in its course. Because the clinical signs of pericardial tamponade can be very unspecific, a high degree of initial suspicion is required to establish the diagnosis. In addition to clinical examination the deployment of imaging techniques is almost always mandatory in order to avoid delays in diagnosis and to initiate any necessary interventions, such as pericardiocentesis or direct cardiac surgical interventions. After a brief overview of how knowledge of PT has developed throughout history, we report on an atypical life-threatening cardiac tamponade after cardiac surgery. A 74-year-old woman was admitted for elective biological aortic valve replacement and aorto-coronary-bypass grafting (left internal mammary artery to left anterior descending artery, single vein graft to right coronary artery). On the 10th postoperative day, the patient unexpectedly deteriorated. She rapidly developed epigastric pain radiating to the left upper abdomen, and features of low peripheral perfusion and shock. There were no clear signs of pericardial tamponade either clinically or echocardiographically. Therefore, for further differential diagnosis, a contrast-enhanced computed tomography scan was performed under clinical suspicion of acute abdomen. Unexpectedly, active bleeding distally from the right coronary anastomosis was revealed. While the patient was prepared for operative revision, she needed cardiopulmonary resuscitation, which was successful. Intraoperatively, the source of bleeding was located and surgically relieved. The subsequent postoperative course was uneventful. CONCLUSIONS In the first days after cardiac surgery, the occurrence of life-threatening situations, such as cardiac tamponade, must be expected. Especially if the symptoms are atypical, the entire diagnostic armamentarium must be applied to identify the origin of the complaints, which may be cardiac, but also non-cardiac. CENTRAL MESSAGE A high level of suspicion, immediate diagnostic confirmation, and rapid treatment are required to recognize and successfully treat such an emergency (Fig. 5). PERSPECTIVE Pericardial tamponade should always be considered as a complication of cardiac surgery, even when symptoms are atypical. The full range of diagnostic tools must be used to identify the origin of the complaints, which may be cardiac, but also non-cardiac (Fig. 5).
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Affiliation(s)
- Ann-Sophie Kaemmerer
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054, Erlangen, Germany.
| | - Khaleel Alkhalaileh
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Mathieu N Suleiman
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Markus Kopp
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Christine Hauer
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias S May
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Weyand
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Frank Harig
- Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054, Erlangen, Germany
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Alerhand S, Adrian RJ, Long B, Avila J. Pericardial tamponade: A comprehensive emergency medicine and echocardiography review. Am J Emerg Med 2022; 58:159-174. [DOI: 10.1016/j.ajem.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/03/2022] [Indexed: 10/18/2022] Open
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Noma M, Hirata Y, Hirahara N, Suzuki T, Miyata H, Hiramatsu Y, Yoshimura Y, Takamoto S. Pericardial effusion after congenital heart surgery. JTCVS OPEN 2022; 9:237-243. [PMID: 36003447 PMCID: PMC9390554 DOI: 10.1016/j.xjon.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 01/12/2022] [Indexed: 11/25/2022]
Abstract
Objective Pericardial effusion after cardiac surgery remains an important cause of morbidity and mortality. We describe the risk factors of pericardial effusion after congenital heart surgery through analyzing data from a nationwide, multi-institutional registry. Methods The Japan Congenital Cardiovascular Surgery Database, which reflects routine clinical care in Japan, was used for this retrospective cohort study. Multivariable regression analysis was done after univariable comparison of patients with pericardial effusion and no pericardial effusion. Results The study enrolled 64,777 patients registered with the Japan Congenital Cardiovascular Surgery Database between 2008 and 2016; 909 of these had postoperative pericardial effusion (1.4%) and were analyzed along with 63,868 patients without pericardial effusion. Univariable analysis found no difference between the groups in terms of gender, early delivery, or preoperative mechanical ventilatory support. In the pericardial effusion group, cardiopulmonary bypass use was lower (58.4% vs 62.1%), whereas the cardiopulmonary bypass time (176.9 vs 139.9 minutes) and aortic crossclamp time (75.1 vs 62.2 minutes) were longer, and 30-day mortality was higher (4.1% vs 2.2%). Multivariable analysis identified trisomy 21 (odds ratio, 1.54), 22q.11 deletion (odds ratio, 2.17), first-time cardiac surgery (odds ratio, 2.01), and blood transfusion (odds ratio, 1.43) as independent risk factors of postoperative pericardial effusion. In contrast, neonates, infants, ventricular septal defect, atrial septal defect, tetralogy of Fallot repair, and arterial switch operation were correlated with a low risk of pericardial effusion development. Conclusions The incidence of postoperative pericardial effusion in congenital cardiac surgery was 1.4%. Trisomy 21, 22q.11 deletion, first-time cardiac surgery, and blood transfusion were identified as the principal factors predicting the need for pericardial effusion drainage.
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11
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Armstrong SM, Thavendiranathan P, Butany J. The pericardium and its diseases. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00021-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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12
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van der Werff MH, van der Kamp HJ, Breur JMPJ. The Efficacy, Safety, and Side Effects of Intrapericardial Triamcinolone Treatment in Children with Post-surgical Pericardial Effusion: A Case Series. Pediatr Cardiol 2022; 43:142-146. [PMID: 34405257 PMCID: PMC8766361 DOI: 10.1007/s00246-021-02704-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/04/2021] [Indexed: 11/20/2022]
Abstract
Intrapericardial triamcinolone can be used to treat chronic pericardial effusion (PE) in adults; however, pediatric data are lacking. In this case series we aim to evaluate the efficacy, safety, and side effects of intrapericardial triamcinolone in children with PE. The incidence and treatment of post-surgical PE from 2009 to 2019 were determined using the institutional surgical database and electronic patient records. Furthermore, a retrospective analysis of efficacy, safety, and side effects of intrapericardial triamcinolone treatment for chronic post-surgical PE was performed. The incidence of postoperative PE requiring treatment was highest after atrial septal defect (ASD) closure when compared to other types of cardiac surgery (9.7% vs 4.3%). Intrapericardial treatment with triamcinolone resolved pericardial effusion in 3 out of 4 patients. All patients developed significant systemic side effects. Surgical ASD closure is associated with an increased risk of development of PE requiring treatment. Intrapericardial triamcinolone is an effective treatment for chronic postoperative PE in children, but is always associated with significant systemic side effects. Close monitoring and treatment of adrenal insufficiency are mandatory in these cases.
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Affiliation(s)
- Manon H. van der Werff
- grid.7692.a0000000090126352Department of Pediatric Cardiology, University Medical Center, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Hetty J. van der Kamp
- grid.7692.a0000000090126352Department of Pediatric Endocrinology, University Medical Center, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Johannes M. P. J. Breur
- grid.7692.a0000000090126352Department of Pediatric Cardiology, University Medical Center, PO Box 85090, 3508 AB Utrecht, The Netherlands
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Ellenbroek DFJ, van Kessel L, Compagner W, Brouwer T, Bouwman RA, van Straten BAHM, Otterspoor LC, De Bie AJR. Diagnostic performance of echocardiography to predict cardiac tamponade after cardiac surgery. Eur J Cardiothorac Surg 2021; 62:6430389. [PMID: 34791128 PMCID: PMC9257667 DOI: 10.1093/ejcts/ezab468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/14/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Dennis F J Ellenbroek
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, Netherlands
| | - Luc van Kessel
- Department of Intensive Care, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
| | - Wilma Compagner
- Department of Intensive Care, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
| | - Tim Brouwer
- Department of Intensive Care, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
| | - R Arthur Bouwman
- Department of Anesthesiology, Catharina Hospital, Eindhoven, Netherlands
| | | | - Luuk C Otterspoor
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Ashley J R De Bie
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Intensive Care, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
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14
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Maranta F, Cianfanelli L, Grippo R, Alfieri O, Cianflone D, Imazio M. Post-pericardiotomy syndrome: insights into neglected postoperative issues. Eur J Cardiothorac Surg 2021; 61:505-514. [PMID: 34672331 DOI: 10.1093/ejcts/ezab449] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/01/2021] [Accepted: 07/27/2021] [Indexed: 12/20/2022] Open
Abstract
ABSTRACT OBJECTIVES Pericardial effusion is a common complication after cardiac surgery, both isolated and in post-pericardiotomy syndrome (PPS), a condition in which pleuropericardial damage triggers both a local and a systemic inflammatory/immune response. The goal of this review was to present a complete picture of PPS and pericardial complications after cardiac surgery, highlighting available evidence and gaps in knowledge. METHODS A literature review was performed that included relevant prospective and retrospective studies on the subject. RESULTS PPS occurs frequently and is associated with elevated morbidity and significantly increased hospital stays and costs. Nevertheless, PPS is often underestimated in clinical practice, and knowledge of its pathogenesis and epidemiology is limited. Several anti-inflammatory drugs have been investigated for treatment but with conflicting evidence. Colchicine demonstrated encouraging results for prevention. CONCLUSIONS Wider adoption of standardized diagnostic criteria to correctly define PPS and start early treatment is needed. Larger studies are necessary to better identify high-risk patients who might benefit from preventive strategies.
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Affiliation(s)
- Francesco Maranta
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Cianfanelli
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Rocco Grippo
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio Alfieri
- Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Domenico Cianflone
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", Udine, Italy
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15
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Echocardiographic Screening for Postoperative Pericardial Effusion in Children. Pediatr Cardiol 2021; 42:1531-1538. [PMID: 34086097 DOI: 10.1007/s00246-021-02637-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
Pericardial effusion (PE) after cardiac surgery can be life threatening without timely detection, and the optimal screening method is unknown. We sought to evaluate the role of a surveillance echocardiogram on postoperative day 10 (± 2), determine the incidence of postoperative PE, and identify risk factors. We conducted a retrospective cohort study including all pediatric patients who underwent open heart surgery at a single institution over a 7-month period. To identify risk factors for PE, medical records of patients with PE detected within 6 weeks after surgery (cases) were compared with patients without PE (controls). Of 203 patients, 52 (26%) had PE within 6 weeks; 42 (81%) were trivial-small and 10 (19%) were moderate-large. Twenty-nine (56%) were first detected within 7 days post-operatively, including all cases developing cardiac tamponade (n = 3). An echocardiogram was done 10 (± 2) days post-operatively in 41/52 cases, of which 12/41 (29%) did not have a PE at this time, 24/41 (59%) had a trivial-small PE, and 5/41(12%) had a moderate-large PE; 2 of the latter had no prior detected PE. Closure of an atrial septal defect had the highest incidence of PE (42%). PE cases were associated with postoperative nasopharyngeal detection of a respiratory virus (OR 3.8, p = 0.03). In conclusion, the majority of PE cases were detected within 7 days post-operatively, including all cases subsequently developing cardiac tamponade. Day 10 echocardiography infrequently detected a moderate or large effusion that had previously gone undiagnosed. A positive perioperative nasopharyngeal aspirate for a respiratory virus was associated with postoperative PE.
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16
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Adi O, Ahmad AH, Fong CP, Ranga A, Panebianco N. Resuscitative transesophageal echocardiography in the diagnosis of post-CABG loculated pericardial clot causing cardiac tamponade. Ultrasound J 2021; 13:22. [PMID: 33856577 PMCID: PMC8050179 DOI: 10.1186/s13089-021-00225-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background Pericardial effusion is a known complication of post-open cardiac surgery which can progress to life-threatening cardiac tamponade. Classical signs of tamponade such as hypotension and pulsus paradoxus are often absent. Diagnosing acute cardiac tamponade with transthoracic echocardiography (TTE) can be challenging in post-cardiac surgical patients due to distorted anatomy and limited scanning windows by the presence of surgical dressings or scar. Additionally, this patient population is more likely to have a loculated pericardial effusion, or an effusion that is isoechoic in appearance secondary to clotted blood. These findings can be challenging to visualize with traditional TTE. Missed diagnosis of cardiac tamponade due to loculated pericardial clot can result in delayed diagnosis and clinical management. Case presentation We report a case series that illustrates the diagnostic challenge and value of resuscitative transesophageal echocardiography (TEE) in the emergency department (ED) for the diagnosis of cardiac tamponade due to posterior loculated pericardial clot in post-surgical coronary artery bypass graft (CABG) patients. Conclusions Cardiac tamponade due to loculated posterior pericardial clot post-CABG requires prompt diagnosis and appropriate management to avoid the potential for hemodynamic instability. Transesophageal echocardiography allows a rapid diagnosis, early appropriate referral and an opportunity to institute appropriate therapeutic measures. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-021-00225-7.
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Affiliation(s)
- Osman Adi
- Resuscitation & Emergency Critical Care Unit, Department of Emergency and Trauma, Raja Permaisuri Bainun Hospital, Jalan Raja Ashman (Jalan Hospital), 30400, Ipoh, Perak, Malaysia.
| | - Azma Haryaty Ahmad
- Resuscitation & Emergency Critical Care Unit, Department of Emergency and Trauma, Raja Permaisuri Bainun Hospital, Jalan Raja Ashman (Jalan Hospital), 30400, Ipoh, Perak, Malaysia
| | - Chan Pei Fong
- Resuscitation & Emergency Critical Care Unit, Department of Emergency and Trauma, Raja Permaisuri Bainun Hospital, Jalan Raja Ashman (Jalan Hospital), 30400, Ipoh, Perak, Malaysia
| | - Asri Ranga
- Department of Cardiology, Hospital Serdang, Serdang, Selangor, Malaysia
| | - Nova Panebianco
- Division of Emergency Ultrasound, Department of Emergency Medicine, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
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Wang EHZ, Ye J, Turgeon R. Safety and Efficacy of Non-Vitamin K Oral Anticoagulant Use Early After Cardiac Surgery: A Systematic Review. Ann Pharmacother 2021; 55:1525-1535. [PMID: 33813916 DOI: 10.1177/10600280211006830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine the safety and efficacy of non-vitamin K oral anticoagulants (NOACs) initiated early after cardiac surgery. DATA SOURCES: Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE (database inception to January 20, 2021), www.clinicaltrials.gov, www.who.int/ictrp/search/en/, NOAC trial registries, and bibliographies of relevant guidelines and other reviews were used. STUDY SELECTION AND DATA EXTRACTION Observational studies and randomized controlled trials (RCTs) that initiated NOACs within the index hospitalization and that reported bleeding for the primary outcome were included. DATA SYNTHESIS A total of 6 cohort studies, 1 RCT, and 3 ongoing RCTs were included. Most studies were single-centered, limited to postoperative atrial fibrillation after coronary artery bypass grafting, and with 30-day follow-up; few studies included patients with isolated bioprosthetic valve replacement or valve repair. Bleeding risk varied (0%-28.6%), and all but one study showed no significantly higher risk with NOAC compared with warfarin. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Overall, NOACs were used in 26% to 37.5% of patients early after cardiac surgery. Starting a NOAC on postoperative day 4 appeared to have similar bleeding rates compared with warfarin, but clinical application is limited by heterogeneity of outcome definitions, confounding, and bias. Compared with warfarin, NOACs may have similar thromboembolism risk, reduced length of stay, and cost. CONCLUSIONS There is limited evidence to guide NOAC use early after cardiac surgery. Three ongoing randomized trials will add to the literature and provide guidance for clinicians on whether, in whom, when, and how to use NOACs safely early after cardiac surgery.
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Affiliation(s)
| | - Jian Ye
- University of British Columbia, Vancouver, BC, Canada
| | - Ricky Turgeon
- University of British Columbia, Vancouver, BC, Canada
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18
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Li L, Zhao L, He J, Han Z. Chylopericardial tamponade after minimally invasive McKeown oesophagectomy. J Thorac Dis 2020; 12:2830-2832. [PMID: 32642193 PMCID: PMC7330401 DOI: 10.21037/jtd.2020.03.98] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Li Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China
| | - Luo Zhao
- Department of Thoracic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China
| | - Jia He
- Department of Thoracic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China
| | - Zhijun Han
- Department of Thoracic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China
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Paulraj S, Raj V, Ashok Kumar P, Voelker R, Smulyan H. Atypical Cardiac Tamponade Manifesting as Left Ventricular Diastolic Collapse: A Case Report. Cureus 2020; 12:e8045. [PMID: 32537266 PMCID: PMC7286439 DOI: 10.7759/cureus.8045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cardiac tamponade is a medical emergency, the diagnosis of which is predominantly clinical with supportive echocardiographic findings. Echocardiographic findings highly suggestive of cardiac tamponade include chamber collapse, inferior vena cava (IVC) plethora, and respiratory volume/flow variations. The right-sided cardiac chambers are a low-pressure system and are the first to show signs of collapse with high specificity for tamponade. We report the case of a 35-year-old woman who demonstrated left ventricular (LV) diastolic collapse on echocardiogram following a tricuspid valve replacement. Although left-sided chamber collapse with tamponade has been reported with localized pericardial effusions postoperatively, our patient had a large circumferential pericardial effusion. Selective chamber compression can be a presenting sign of postoperative tamponade after cardiac surgery. Our case highlights the importance of recognizing atypical forms of cardiac tamponade to help in early identification and emergent management in such patients.
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Affiliation(s)
- Shweta Paulraj
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Vijay Raj
- Cardiology, State University of New York Upstate Medical University, Syracuse, USA
| | - Prashanth Ashok Kumar
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Robert Voelker
- Cardiology, State University of New York Upstate Medical University, Syracuse, USA
| | - Harold Smulyan
- Cardiology, State University of New York Upstate Medical University, Syracuse, USA
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Routine postoperative computed tomography is superior to cardiac ultrasonography for predicting delayed cardiac tamponade. Int J Cardiovasc Imaging 2020; 36:1371-1376. [PMID: 32221770 DOI: 10.1007/s10554-020-01820-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/19/2020] [Indexed: 10/24/2022]
Abstract
Delayed cardiac tamponade (DCT) can be a fatal complication after cardiac surgery, but its early diagnosis and/or prediction is sometimes difficult. This study aimed to confirm the efficacy of postoperative computed tomography (CT) as routine examination compared with transthoracic echocardiography (TTE) for predicting DCT after cardiac surgery. This study was a retrospective single-center analysis of 485 consecutive patients undergoing cardiac surgery from January 2016 to July 2018 in our department. Among them, 237 patients were enrolled in this analysis after application of the exclusion criteria: minimally invasive surgery via small thoracotomy, death in the acute phase, and no CT 7 ± 3 days after surgery. Pericardial effusion (PE) was measured at the thickest part using CT and TTE. DCT was found in nine enrolled patients (3.8%). The mean PE on CT was 7.7 ± 5.5 mm in the no event group and 23.4 ± 5.7 mm in the DCT group (p = 0.026), whereas the mean PE on TTE was 6.2 ± 4.5 mm in the no event group and 10.8 ± 4.4 mm in the DCT group (p = 0.170). On multivariate analysis, PE greater than 20 mm on CT (Odds ratio, 13.93; 95% confidence interval 2.57-75.46; p = 0.002) was a significant predictor of DCT. The present study suggested that postoperative CT examination is superior to TTE for predicting DCT. If PE is less than 20 mm on CT, it could be treated conservatively; otherwise, preventive/therapeutic intervention should be considered.
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21
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Right pericardial window opening: a method of preventing pericardial effusion. Gen Thorac Cardiovasc Surg 2019; 68:485-491. [PMID: 31559587 DOI: 10.1007/s11748-019-01213-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/14/2019] [Indexed: 10/25/2022]
Abstract
AIM In this study, we aimed to investigate the superiority of right pericardial window (RPW) versus posterior pericardial drain placing for the parameters of pericardial effusion and the postoperative complications at the patients who has undergone cardiac surgery. MATERIALS AND METHODS Between July and September 2018, 120 adult patients (mean age 50.30 ± 14.61) who underwent cardiac surgery without the necessity of opening the pleura were included in the study. In Group 1, the RPW was opened (n = 60), and Group 2 posterior pericardial drainage tube was placed without RPW (n = 60). Risk factors and postoperative complication were evaluated and compared between the Groups. RESULTS Cardiac tamponade occurrence was not significantly different between the Groups (Group 1, n = 0 and Group 2, n = 3, p = 0.079). Postoperative transthoracic echocardiographic controls revealed significant pericardial effusion in Group 2 (6.90 mm ± 13.02 mm) compared to Group 1 (2.30 mm ± 5.60 mm) (p = 0.013). Postoperative creatinine levels were 0.75 ± 0.26 in Group 1 and 0.88 ± 0.36 in Group 2 (p = 0.022). A significant decrease in glomerular filtration rate was observed in Group 2 (102.7 ± 24.5 and 91.2 ± 28, p = 0.019). Postoperative acute renal failure was significantly higher in Group 2 compared to Group 1 (p < 0.001). Postoperative new onset atrial fibrillation occurred in 4 patients in Group 1 and 8 in Group 2 (p = 0.224). The duration of intensive care unit stay was 36.00 ± 22.31 h in Group 1 and 53.60 ± 59.50 h in Group 2 (p = 0.034). Development of pneumothorax, pneumonia and pleural effusion were not statistically different between the Groups (p = 0.079, 0.171, 0.509). CONCLUSION RPW application is more effective on preventing postoperative complications in cardiac surgery instead of placing drains in posterior pericardium.
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22
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Yu P, Lin D, Catalano M, Cassiere H, Manetta F, Kohn N, Hartman A. Impact of novel oral anticoagulants vs warfarin on effusions after coronary artery bypass grafting. J Card Surg 2019; 34:419-423. [DOI: 10.1111/jocs.14054] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/21/2019] [Accepted: 03/26/2019] [Indexed: 01/24/2023]
Affiliation(s)
- Pey‐Jen Yu
- Division of Cardiovascular and Thoracic SurgeryZucker School of Medicine at Hofstra/NorthwellManhasset New York
| | - Dishen Lin
- Division of Cardiovascular and Thoracic SurgeryZucker School of Medicine at Hofstra/NorthwellManhasset New York
| | - Michael Catalano
- Division of Cardiovascular and Thoracic SurgeryZucker School of Medicine at Hofstra/NorthwellManhasset New York
| | - Hugh Cassiere
- Division of Cardiovascular and Thoracic SurgeryZucker School of Medicine at Hofstra/NorthwellManhasset New York
| | - Frank Manetta
- Division of Cardiovascular and Thoracic SurgeryZucker School of Medicine at Hofstra/NorthwellManhasset New York
| | - Nina Kohn
- Department of BiostatisticsThe Feinstein Institute for Medical ResearchManhasset New York
| | - Alan Hartman
- Division of Cardiovascular and Thoracic SurgeryZucker School of Medicine at Hofstra/NorthwellManhasset New York
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23
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Rego A, Cheung PC, Harris WJ, Brady KM, Newman J, Still R. Pericardial closure with extracellular matrix scaffold following cardiac surgery associated with a reduction of postoperative complications and 30-day hospital readmissions. J Cardiothorac Surg 2019; 14:61. [PMID: 30876459 PMCID: PMC6419853 DOI: 10.1186/s13019-019-0871-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/17/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A prospective, multi-center study (RECON) was conducted to evaluate the clinical outcomes of pericardial closure using a decellularized extracellular matrix (ECM) graft derived from porcine small intestinal submucosa. METHODS Patients indicated for open cardiac surgery with pericardial closure using ECM were eligible for the RECON study cohort. Postoperative complications and readmission of the RECON patients were compared to the patient cohort in the Nationwide Readmissions Database (NRD). Inverse probability of treatment weighting was used to control the differences in patient demographics, comorbidities, and risk factors. RESULTS A total of 1420 patients at 42 centers were enrolled, including 923 coronary artery bypass grafting (CABG) surgeries and 436 valve surgeries. Significantly fewer valve surgery patients in the RECON cohort experienced pleural effusion (3.1% vs. 13.0%; p < 0.05) and pericardial effusion (1.5% vs. 2.6%; p < 0.05) than in the NRD cohort. CABG patients in the RECON cohort were less likely to suffer bleeding (1.2% vs. 2.9%; p < 0.05) and pericardial effusion (0.2% vs. 2.2%, p < 0.05) than those in the NRD cohort. The 30-day all-cause hospital readmission rate was significantly lower among RECON patients than NRD patients following both valve surgery (HR: 0.34; p < 0.05) and CABG surgery (HR: 0.42; p < 0.05). In the RECON study, 14.4% of CABG patients and 27.0% of valve patients had postoperative atrial fibrillation as compared to previously reported risks, which generally ranges from 20 to 30% after CABG and from 35 to 50% after valve surgery. CONCLUSIONS Pericardial closure with ECM following cardiac surgery is associated with a reduction in the proportion of patients with pleural effusion, pericardial effusion, and 30-day readmission compared to a nationwide database. TRIAL REGISTRATION NCT02073331 , Registered on February 27, 2014.
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Affiliation(s)
- Alfredo Rego
- South Florida Heart & Lung Institute, 3650 NW 82nd Ave, Doral, FL 33166 USA
| | - Patricia C. Cheung
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA USA
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Ahmed OF, kakamad FH, Al-Neaimy SY, Salih RQ, Mohammed SH, Salih AM. Outcome of combined coronary artery bypass grafting and aortic valve replacement; a case series. INTERNATIONAL JOURNAL OF SURGERY OPEN 2019. [DOI: 10.1016/j.ijso.2019.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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25
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Bari G, Szűcs S, Érces D, Boros M, Varga G. Experimental pericardial tamponade-translation of a clinical problem to its large animal model. Turk J Surg 2018; 34:205-211. [PMID: 30302425 DOI: 10.5152/turkjsurg.2018.4181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/18/2018] [Indexed: 11/22/2022]
Abstract
Objectives Pericardial tamponade is a life-threatening medical emergency, when the hemodynamic consequences of low cardiac output severely disturb the perfusion of the peripheral tissues. Our aim was to design a reliable large animal model to reproduce the clinical scenario with the relevant pathophysiological consequences of pericardial tamponade -induced cardiogenic shock. Material and Methods Anesthetized Vietnamese mini pigs were used (n=12). Following laparotomy, a cannula was fixed into the pericardium through the diaphragm without thoracotomy. A sham-operated group (n=6) served as control, while in the second group (n=6) pericardial tamponade was induced by intra-pericardial injection of heparinized own blood. Throughout the 60-min pericardial tamponade and the 180-min reperfusion, macro hemodynamics, renal circulation and the mesenteric macro- and micro-circulatory parameters were monitored. Myeloperoxidase activity was measured to detect neutrophil leukocyte accumulation and in vivo histology was performed by confocal laser scanning endomicroscopy to observe the structural changes of the intestinal mucosa. Results PT increased the central venous pressure, heart rate, and decreased mean arterial pressure. The mesenteric artery flow (from 355.5±112.4 vs 182.0±59.1 mL/min) and renal arterial flow (from 159.63±50.7 vs 35.902±27.9 mL//min) and the micro-circulation of the ileum was reduced. The myeloperoxidase activity was elevated (from 3.66±1.6 to 7.01±1.44 mU/mg protein) and manifest injury of the ileal mucosa was present. Conclusion This experimental model suitably mimics the hemodynamics and the pathology of clinical pericardial tamponade situations, and on this basis, it provides an opportunity to study the adverse macro- and micro-circulatory effects and biochemical consequences of human cardiogenic shock.
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Affiliation(s)
- Gábor Bari
- Department of Cardiac Surgery, Szeged University, Szeged, Hungary
| | - Szilárd Szűcs
- Institute of Surgical Research, Szeged University, Szeged, Hungary
| | - Dániel Érces
- Institute of Surgical Research, Szeged University, Szeged, Hungary
| | - Mihály Boros
- Institute of Surgical Research, Szeged University, Szeged, Hungary
| | - Gabriella Varga
- Institute of Surgical Research, Szeged University, Szeged, Hungary
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Hunter NM, Stahl D. Localized Cardiac Tamponade Diagnosed Using Venous Oxygen Saturation. J Cardiothorac Vasc Anesth 2018; 33:489-492. [PMID: 30269892 DOI: 10.1053/j.jvca.2018.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Nakia M Hunter
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH.
| | - David Stahl
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
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Sridhara S, Lichtenwalter C, Mazdeh S, Yeneneh BT. Positive Murphy's Sign in Pericardial Hematoma from a Right Atrial Tear. Cureus 2018; 10:e3402. [PMID: 30533336 PMCID: PMC6279000 DOI: 10.7759/cureus.3402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A positive Murphy's sign in a patient with right upper quadrant abdominal pain is the arrest of inspiration during deep palpation of the quadrant. It is usually suggestive of acute cholecystitis. We report an unusual case of a positive Murphy's sign not due to acute cholecystitis, but rather from a pericardial hematoma from a right atrial tear causing right heart failure. The patient required an atrial tear repair to prevent a cardiac tamponade.
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Kruse T, Wahl S, Guthrie PF, Sendelbach S. Place Atrium to Water Seal (PAWS): Assessing Wall Suction Versus No Suction for Chest Tubes After Open Heart Surgery. Crit Care Nurse 2018; 37:17-28. [PMID: 28765351 DOI: 10.4037/ccn2017269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Traditionally chest tubes are set to -20 cm H2O wall suctioning until removal to facilitate drainage of blood, fluid, and air from the pleural or mediastinal space in patients after open heart surgery. However, no clear evidence supports using wall suction in these patients. Some studies in patients after pulmonary surgery indicate that using chest tubes with a water seal is safer, because this practice decreases duration of chest tube placement and eliminates air leaks. OBJECTIVE To show that changing chest tubes to a water seal after 12 hours of wall suction (intervention) is a safe alternative to using chest tubes with wall suction until removal of the tubes (usual care) in patients after open heart surgery. METHODS A before-and-after quality improvement design was used to evaluate the differences between the 2 chest tube management approaches in chest tube complications, output, and duration of placement. RESULTS A total of 48 patients received the intervention; 52 received usual care. The 2 groups (intervention vs usual care) did not differ significantly in complications (0 vs 2 events; P = .23), chest tube output (H1 = 0.001, P = .97), or duration of placement (median, 47 hours for both groups). CONCLUSION Changing chest tubes from wall suction to water seal after 12 hours of wall suction is a safe alternative to using wall suctioning until removal of the tubes.
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Affiliation(s)
- Tamara Kruse
- Tamara Kruse is a critical care nurse educator, Good Samaritan Regional Medical Center, Corvallis, Oregon. .,Sharon Wahl is a clinical nurse specialist, Abbott Northwestern Hospital, Allina Health, Minneapolis, Minnesota. .,Patricia Finch Guthrie is director, Interprofessional Education, Research, and Practice, and an assistant professor, St. Catherine University, Saint Paul, Minnesota. .,Sue Sendelbach is the director of nursing research, Abbott Northwestern Hospital, Minneapolis, Minnesota.
| | - Sharon Wahl
- Tamara Kruse is a critical care nurse educator, Good Samaritan Regional Medical Center, Corvallis, Oregon.,Sharon Wahl is a clinical nurse specialist, Abbott Northwestern Hospital, Allina Health, Minneapolis, Minnesota.,Patricia Finch Guthrie is director, Interprofessional Education, Research, and Practice, and an assistant professor, St. Catherine University, Saint Paul, Minnesota.,Sue Sendelbach is the director of nursing research, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Patricia Finch Guthrie
- Tamara Kruse is a critical care nurse educator, Good Samaritan Regional Medical Center, Corvallis, Oregon.,Sharon Wahl is a clinical nurse specialist, Abbott Northwestern Hospital, Allina Health, Minneapolis, Minnesota.,Patricia Finch Guthrie is director, Interprofessional Education, Research, and Practice, and an assistant professor, St. Catherine University, Saint Paul, Minnesota.,Sue Sendelbach is the director of nursing research, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Sue Sendelbach
- Tamara Kruse is a critical care nurse educator, Good Samaritan Regional Medical Center, Corvallis, Oregon.,Sharon Wahl is a clinical nurse specialist, Abbott Northwestern Hospital, Allina Health, Minneapolis, Minnesota.,Patricia Finch Guthrie is director, Interprofessional Education, Research, and Practice, and an assistant professor, St. Catherine University, Saint Paul, Minnesota.,Sue Sendelbach is the director of nursing research, Abbott Northwestern Hospital, Minneapolis, Minnesota
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Gabrysz-Forget F, Hébert M, Denault A, Perrault LP. Rapid relief of a postcardiotomy tamponade by manual subxiphoid decompression: a useful approach in the intensive care unit. Interact Cardiovasc Thorac Surg 2018; 27:310-311. [PMID: 29546374 DOI: 10.1093/icvts/ivy051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/02/2018] [Indexed: 11/13/2022] Open
Abstract
This case report presents a manual decompression technique used to decompress a postoperative tamponade compressing right chambers. It consists of lateral movements following subxiphoid finger insertion. This is an accessible procedure to rapidly stabilize the haemodynamics of the patient in the intensive care unit to buy time before operating room (OR) revision.
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Affiliation(s)
- Fanny Gabrysz-Forget
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Mélanie Hébert
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - André Denault
- Department of Anesthesiology, Montreal Heart Institute, Montreal, QC, Canada
| | - Louis P Perrault
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, QC, Canada
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Wamboldt R, Bisleri G, Glover B, Haseeb S, Tse G, Liu T, Baranchuk A. Primary prevention of post-pericardiotomy syndrome using corticosteroids: a systematic review. Expert Rev Cardiovasc Ther 2018; 16:405-412. [PMID: 29745734 DOI: 10.1080/14779072.2018.1475231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Rachel Wamboldt
- Division of Cardiology, Kingston Health Science Center, Queen’s University, Kingston, Canada
| | - Gianluigi Bisleri
- Division of Cardiovascular Surgery, Kingston Health Science Center, Queen’s University, Kingston, Canada
| | - Benedict Glover
- Division of Cardiology, Kingston Health Science Center, Queen’s University, Kingston, Canada
| | - Sohaib Haseeb
- Division of Cardiology, Kingston Health Science Center, Queen’s University, Kingston, Canada
| | - Gary Tse
- Department of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R., China
| | - Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology Second Hospital of Tianjin Medical University, Tianjin, China
| | - Adrian Baranchuk
- Division of Cardiology, Kingston Health Science Center, Queen’s University, Kingston, Canada
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Leiva EH, Carreño M, Bucheli FR, Bonfanti AC, Umaña JP, Dennis RJ. Factors associated with delayed cardiac tamponade after cardiac surgery. Ann Card Anaesth 2018; 21:158-166. [PMID: 29652277 PMCID: PMC5914216 DOI: 10.4103/aca.aca_147_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Cardiac tamponade (CT) following cardiac surgery is a potentially fatal complication and the cause of surgical reintervention in 0.1%-6% of cases. There are two types of CT: acute, occurring within the first 48 h postoperatively, and subacute or delayed, which occurs more than 48 h postoperatively. The latter does not show specific clinical signs, which makes it more difficult to diagnose. The factors associated with acute CT (aCT) are related to coagulopathy or surgical bleeding, while the variables associated with subacute tamponade have not been well defined. Aims The primary objective of this study was to identify the factors associated with the development of subacute CT (sCT). Settings and Design This report describes a case (n = 80) and control (n = 160) study nested in a historic cohort made up of adult patients who underwent any type of urgent or elective cardiac surgery in a tertiary cardiovascular hospital. Methods: The occurrence of sCT was defined as the presence of a compatible clinical picture, pericardial effusion and confirmation of cardiac tamponade during the required emergency intervention at any point between 48 hours and 30 days after surgery. All factors potentially related to the development of sCT were taken into account. Statistical Analysis Used For the adjusted analysis, a logistical regression was constructed with 55 variables, including pre-, intra-, and post-operative data. Results The mortality of patients with sCT was 11% versus 0% in the controls. Five variables were identified as independently and significantly associated with the outcome: pre- or post-operative anticoagulation, reintervention in the first 48 h, surgery other than coronary artery bypass graft, and red blood cell transfusion. Conclusions Our study identified five variables associated with sCT and established that this complication has a high mortality rate. These findings may allow the implementation of standardized follow-up measures for patients identified as higher risk, leading to either early detection or prevention.
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Affiliation(s)
- Edgar Hernández Leiva
- Department of Cardiology, Instituto de Cardiología-Fundación Cardioinfantil, Universidad del Rosario, Bogotà DC, Colombia
| | - Marisol Carreño
- Department of Cardiovascular Surgery, Instituto de Cardiología-Fundación Cardioinfantil, Universidad del Rosario, Bogotà DC, Colombia
| | - Fernando Rada Bucheli
- Department of Cardiology, Instituto de Cardiología-Fundación Cardioinfantil, Universidad del Rosario, Bogotà DC, Colombia
| | - Alberto Cadena Bonfanti
- Department of Cardiology, Instituto de Cardiología-Fundación Cardioinfantil, Universidad del Rosario, Bogotà DC, Colombia
| | - Juan Pablo Umaña
- Department of Cardiovascular Surgery, Instituto de Cardiología-Fundación Cardioinfantil, Universidad del Rosario, Bogotà DC, Colombia
| | - Rodolfo José Dennis
- Department of Internal Medicine, Instituto de Cardiología-Fundación Cardioinfantil, Universidad del Rosario, Bogotà DC, Colombia
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Nguyen HS, Nguyen HDT, Vu TD. Pericardial effusion following cardiac surgery. A single-center experience. Asian Cardiovasc Thorac Ann 2017; 26:5-10. [PMID: 29171276 DOI: 10.1177/0218492317744902] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Pericardial effusion is still a common postoperative complication after open heart surgery with cardiopulmonary bypass. Pericardial effusion significantly prolongs the hospital stay and associated costs as well as affecting overall outcomes after open heart surgery in Hanoi Heart Hospital, a tertiary hospital in Vietnam with an annual volume of 1000 patients. This study aimed to investigate the clinical presentation, incidence, and risk factors of postoperative pericardial effusion, which may ensure better prevention of pericardial effusion and improvement in surgical outcomes after open heart surgery. Methods A cross-sectional study was performed on 1127 patients undergoing open heart surgery from January 2015 to December 2015. Results Thirty-six (3.19%) patients developed pericardial effusion. Of these, 16 (44.4%) had cardiac tamponade. Pericardial effusion occurred after valve procedures in 77.8% of cases. Pericardial effusion was detected after discharge in 47.2% of cases at a mean time of 18.1 ± 13.7 days. Univariate logistic regression analysis showed that age > 25 years, body surface area ≥ 1.28 m2, preoperative liver dysfunction, New York Heart Association class III/IV, left ventricular end-diastolic diameter z score ≥ 0.55, and postoperative anticoagulant use were associated with postoperative pericardial effusion. Multivariate logistic regression analysis showed that left ventricular end-diastolic diameter z score ≥ 0.55 was an independent risk factor for postoperative pericardial effusion. Conclusions Routine postoperative echocardiography is necessary to detect postoperative pericardial effusion. Increased left ventricular end-diastolic dimension is an independent predictor of postoperative pericardial effusion.
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Affiliation(s)
| | | | - Thang Duc Vu
- 3 Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
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Khan NK, Järvelä KM, Loisa EL, Sutinen JA, Laurikka JO, Khan JA. Incidence, presentation and risk factors of late postoperative pericardial effusions requiring invasive treatment after cardiac surgery. Interact Cardiovasc Thorac Surg 2017; 24:835-840. [PMID: 28329077 DOI: 10.1093/icvts/ivx011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/03/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Occurrence and risk factors of late postoperative pericardial effusions requiring invasive treatment, i.e. pretamponade and tamponade, following cardiac surgery are incompletely described in current literature. The purpose of this study was to define the incidence and presentation of late pretamponade and tamponade as well as to outline significant predisposing factors. METHODS A cohort of 1356 consecutive cardiac surgery patients treated in a tertiary academic centre between January 2013 and December 2014 was followed up for 6 months after surgery. Pericardial effusion was considered late when presenting after the 7th postoperative day. The incidence, timing and risk factors, as well as symptoms and clinical findings associated with late pretamponade and tamponade in patients surviving at least 7 days was analysed. RESULTS Of 1308 patients included in the analysis, 81 (6.2%) underwent invasive treatment for late postoperative pericardial effusion, 27 (2.1%) for pretamponade and 54 (4.1%) for tamponade, respectively, with a median delay of 11 (range 8-87) days after the primary operation. Haemodynamic instability was present in 34.6%, signs of cardiac chamber compression in 54.3% and subjective symptoms, mostly dyspnoea, in 56.8% of patients, respectively. Treated patients were younger, had lower EuroSCORE-II rating, less coronary disease, better cardiac function, higher preoperative haemoglobin values and had mostly undergone elective surgery involving cardiac valves. In multivariable analysis, independent risk factors were single valve surgery and high preoperative haemoglobin level, whereas age 60-69 years was associated with lower risk. CONCLUSIONS Younger, generally healthier patients undergoing valve surgery are at greatest risk for developing late tamponade or pretamponade.
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Affiliation(s)
- Niina K Khan
- Department of Vascular Surgery, Tampere University Hospital, Tampere, Finland
| | - Kati M Järvelä
- Department of Cardio-Thoracic Surgery, Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Eetu L Loisa
- School of Medicine, University of Tampere, Tampere, Finland
| | | | - Jari O Laurikka
- Department of Cardio-Thoracic Surgery, Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Jahangir A Khan
- Department of Cardio-Thoracic Surgery, Heart Hospital, Tampere University Hospital, Tampere, Finland
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Saha S, Baraki H, Kutschka I, Hadem J. Predictive value of ScvO 2 monitoring for pericardial tamponade after cardiac surgery. Herz 2017; 44:76-81. [PMID: 29043406 DOI: 10.1007/s00059-017-4629-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/10/2017] [Accepted: 09/11/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND We examined the predictive value of central venous oxygen saturation (ScvO2) changes regarding the occurrence of pericardial tamponade following cardiac surgery. METHODS We retrospectively identified 66 consecutive patients in whom ScvO2 and arterial lactate levels were analyzed during an 8‑h time interval preceding pericardiotomy due to pericardial tamponade (PT), and at equivalent time points in 30 control patients (C) who had an uncomplicated course. RESULTS The median age of the patients was 74 years (interquartile range, 63-78). Three percent of procedures were re-operations. There were no differences between the baseline values of PT and C patients. Pericardiotomy was performed on average 1 day (0-3.5) after cardiac surgery. PT patients displayed a significant decline (p < 0.001) to lower ScvO2 levels (p < 0.001) and a significant increase (p = 0.005) to higher arterial lactate levels (p = 0.019) during the 8 h preceding pericardiotomy, whereas C patients did not (p = 0.440 and p = 0.279, respectively). PT was associated with a longer hospital stay (p = 0.04) and a higher in-hospital mortality (p = 0.008). An ScvO2 decline below 60% (p = 0.018), a delta ScvO2 decline greater than 5% (p = 0.001), and a delta lactate increase greater than 0.18 mmol/l (p = 0.002) during the 8 h preceding pericardiotomy were independently associated with PT. None of these parameters predicted in-hospital mortality. CONCLUSION Deteriorations in ScvO2 might serve as an early marker of PT following cardiac surgery.
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Affiliation(s)
- S Saha
- Department of Cardiothoracic Surgery, University Clinic, Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - H Baraki
- Department of Cardiothoracic Surgery, University Clinic, Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - I Kutschka
- Department of Cardiothoracic Surgery, University Clinic, Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - J Hadem
- Department of Cardiothoracic Surgery, University Clinic, Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.
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Horr SE, Mentias A, Houghtaling PL, Toth AJ, Blackstone EH, Johnston DR, Klein AL. Comparison of Outcomes of Pericardiocentesis Versus Surgical Pericardial Window in Patients Requiring Drainage of Pericardial Effusions. Am J Cardiol 2017; 120:883-890. [PMID: 28739031 DOI: 10.1016/j.amjcard.2017.06.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 05/17/2017] [Accepted: 06/05/2017] [Indexed: 10/19/2022]
Abstract
Comparative outcomes of patients undergoing pericardiocentesis or pericardial window are limited. Development of pericardial effusion after cardiac surgery is common but no data exist to guide best management. Procedural billing codes and Cleveland Clinic surgical registries were used to identify 1,281 patients who underwent either pericardiocentesis or surgical pericardial window between January 2000 and December 2012. The 656 patients undergoing an intervention for a pericardial effusion secondary to cardiac surgery were also compared. Propensity scoring was used to identify well-matched patients in each group. In the overall cohort, in-hospital mortality was similar between the group undergoing pericardiocentesis and surgical drainage (5.3% vs 4.4%, p = 0.49). Similar outcomes were found in the propensity-matched group (4.9% vs 6.1%, p = 0.55). Re-accumulation was more common after pericardiocentesis (24% vs 10%, p <0.0001) and remained in the matched cohorts (23% vs 9%, p <0.0001). The secondary outcome of hemodynamic instability after the procedure was more common in the pericardial window group in both the unmatched (5.2% vs 2.9%, p = 0.036) and matched cohorts (6.1% vs 2.0%, p = 0.022). In the subgroup of patients with a pericardial effusion secondary to cardiac surgery, there was a lower mortality after pericardiocentesis in the unmatched group (1.5% vs 4.6%, p = 0.024); however, after adjustment, this difference in mortality was no longer present (2.6% vs 4.5%, p = 0.36). In conclusion, both pericardiocentesis and surgical pericardial window are safe and effective treatment strategies for the patient with a pericardial effusion. In our study there were no significant differences in mortality in patients undergoing either procedure. Observed differences in outcomes with regard to recurrence rates, hemodynamic instability, and in those with postcardiac surgery effusions may help to guide the clinician in management of the patient requiring therapeutic or diagnostic drainage of a pericardial effusion.
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Davidson WS, Heink A, Sexmith H, Dolan LM, Gordon SM, Otvos JD, Melchior JT, Elder DA, Khoury J, Geh E, Shah AS. Obesity is associated with an altered HDL subspecies profile among adolescents with metabolic disease. J Lipid Res 2017; 58:1916-1923. [PMID: 28743729 DOI: 10.1194/jlr.m078667] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/23/2017] [Indexed: 12/12/2022] Open
Abstract
We aimed to determine the risk factors associated with the depletion of large HDL particles and enrichment of small HDL particles observed in adolescents with T2D. Four groups of adolescents were recruited: 1) lean insulin-sensitive (L-IS), normal BMI and no insulin resistance; 2) lean insulin-resistant (L-IR), normal BMI but insulin resistance (fasting insulin levels ≥ 25 mU/ml and homeostatic model assessment of insulin resistance ≥ 6); 3) obese insulin-sensitive (O-IS), BMI ≥ 95th percentile and no insulin resistance; and 4) obese insulin-resistant (O-IR), BMI ≥ 95th percentile and insulin resistance. Plasma was separated by using gel-filtration chromatography to assess the HDL subspecies profile and compared with that of obese adolescents with T2D (O-T2D). Large HDL subspecies were significantly lower across groups from L-IS > L-IR > O-IS > O-IR > O-T2D (P < 0.0001); small HDL particles were higher from L-IS to O-T2D (P < 0.0001); and medium-sized particles did not differ across groups. The contributions of obesity, insulin resistance, and diabetes to HDL subspecies profile were between 23% and 28%, 1% and 10%, and 4% and 9%, respectively. Obesity is the major risk factor associated with the altered HDL subspecies profile previously reported in adolescents with T2D, with smaller contributions from insulin resistance and diabetes.
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Affiliation(s)
- W Sean Davidson
- Center for Lipid and Arteriosclerosis Science, Department of Pathology and Laboratory Medicine, University of Cincinnati, Cincinnati, OH 45237-0507
| | - Anna Heink
- Department of Pediatrics, Cincinnati Children's Hospital Research Foundation, Cincinnati, OH 45229-3039
| | - Hannah Sexmith
- Department of Pediatrics, Cincinnati Children's Hospital Research Foundation, Cincinnati, OH 45229-3039
| | - Lawrence M Dolan
- Department of Pediatrics, Cincinnati Children's Hospital Research Foundation, Cincinnati, OH 45229-3039
| | - Scott M Gordon
- Lipoprotein Metabolism Section, National Heart, Lung, and Blood Institute, Bethesda, MD 20892
| | - James D Otvos
- Laboratory Corporation of America Holdings, Morrisville, NC 27560
| | - John T Melchior
- Center for Lipid and Arteriosclerosis Science, Department of Pathology and Laboratory Medicine, University of Cincinnati, Cincinnati, OH 45237-0507
| | - Deborah A Elder
- Department of Pediatrics, Cincinnati Children's Hospital Research Foundation, Cincinnati, OH 45229-3039
| | - Jane Khoury
- Department of Pediatrics, Cincinnati Children's Hospital Research Foundation, Cincinnati, OH 45229-3039
| | - Esmond Geh
- Department of Pediatrics, Cincinnati Children's Hospital Research Foundation, Cincinnati, OH 45229-3039
| | - Amy S Shah
- Department of Pediatrics, Cincinnati Children's Hospital Research Foundation, Cincinnati, OH 45229-3039
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Tauriainen T, Kinnunen EM, Koski-Vähälä J, Mosorin MA, Airaksinen J, Biancari F. Outcome after procedures for retained blood syndrome in coronary surgery. Eur J Cardiothorac Surg 2017; 51:1078-1085. [DOI: 10.1093/ejcts/ezx015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Elias MD, Glatz AC, O'Connor MJ, Schachtner S, Ravishankar C, Mascio CE, Cohen MS. Prevalence and Risk Factors for Pericardial Effusions Requiring Readmission After Pediatric Cardiac Surgery. Pediatr Cardiol 2017; 38:484-494. [PMID: 27900408 DOI: 10.1007/s00246-016-1540-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 11/21/2016] [Indexed: 12/18/2022]
Abstract
Pericardial effusion (PE) may require readmission after cardiac surgery and has been associated with postoperative morbidity and mortality. We sought to identify the prevalence and risk factors for postoperative PE requiring readmission in children. A retrospective analysis of the Pediatric Health Information System database was performed between January 1, 2003, and September 30, 2014. All patients ≤18 years old who underwent cardiac surgery were identified by ICD-9 codes. Those readmitted within 1 year with an ICD-9 code for PE were identified. Logistic regression analysis was performed to determine risk factors for PE readmissions. Of the 142,633 surgical admissions, 1535 (1.1%) were readmitted with PE. In multivariable analysis, older age at the initial surgical admission [odds ratio (OR) 1.17, p < 0.001], trisomy 21 (OR 1.24, p = 0.015), geographic region (OR 1.33-1.48, p ≤ 0.001), and specific surgical procedures [heart transplant (OR 1.82, p < 0.001), systemic-pulmonary artery shunt (OR 2.23, p < 0.001), and atrial septal defect surgical repair (OR 1.34, p < 0.001)] were independent risk factors for readmission with PE. Of readmitted patients, 44.2% underwent an interventional PE procedure. Factors associated with interventions included shorter length of stay (LOS) for the initial surgical admission (OR 0.85, p = 0.008), longer LOS for the readmission (OR 1.37, p < 0.001), and atrial septal defect surgery (OR 1.40, p = 0.005). In this administrative database of children undergoing cardiac surgery, readmissions for PE occurred after 1.1% of cardiac surgery admissions. The risk factors identified for readmissions and interventions may allow for improved risk stratification, family counseling, and earlier recognition of PE for children undergoing cardiac surgery.
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Affiliation(s)
- Matthew D Elias
- Division of Cardiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Suite 8NW58, Philadelphia, PA, 19104, USA.
| | - Andrew C Glatz
- Division of Cardiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Suite 8NW58, Philadelphia, PA, 19104, USA
| | - Matthew J O'Connor
- Division of Cardiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Suite 8NW58, Philadelphia, PA, 19104, USA
| | - Susan Schachtner
- Division of Cardiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Suite 8NW58, Philadelphia, PA, 19104, USA
| | - Chitra Ravishankar
- Division of Cardiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Suite 8NW58, Philadelphia, PA, 19104, USA
| | - Christoper E Mascio
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Meryl S Cohen
- Division of Cardiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Suite 8NW58, Philadelphia, PA, 19104, USA
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You SC, Shim CY, Hong GR, Kim D, Cho IJ, Lee S, Chang HJ, Ha JW, Chang BC, Chung N. Incidence, Predictors, and Clinical Outcomes of Postoperative Cardiac Tamponade in Patients Undergoing Heart Valve Surgery. PLoS One 2016; 11:e0165754. [PMID: 27855225 PMCID: PMC5113894 DOI: 10.1371/journal.pone.0165754] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/17/2016] [Indexed: 12/19/2022] Open
Abstract
This study aimed to investigate the incidence, predictors, and clinical outcomes of cardiac tamponade after heart valve surgery. A total of 556 patients who underwent heart valve surgery in a single tertiary center between January 2010 and March 2012 were studied. All patients underwent transthoracic echocardiography (TTE) about 5 days after surgery and TTE was repeated regularly. Patients with suspected acute pericardial hemorrhage were excluded. Cardiac tamponade occurred in twenty-four (4.3%) patients and all underwent surgical or percutaneous pericardial drainage. The median time of pericardial drainage after surgery was 17 (interquartile range, IQR, 13–30) days. Infective endocarditis, mechanical valve replacement of aortic or mitral valve, and any amount of pericardial effusion (PE) on the first postoperative TTE were related to the occurrence of cardiac tamponade (all p<0.05). After multivariate adjustment, occurrence of cardiac tamponade was associated with any amount of PE on the first postoperative TTE (hazard ratio, HR, 14.00, p<0.001) and mechanical valve replacement (HR 2.69, p = 0.025). The mean hospital days in patients with cardiac tamponade was higher than those without (34.9 vs. 13.5, p = 0.031). After pericardial drainage, there was no echocardiographic recurrence of significant PE during a median of 34.8 (IQR 14.9–43.7) months after surgery. Cardiac tamponade after heart valve surgery is not uncommon. Patients with any amount of PE at the first postoperative TTE or mechanical valve replacement should receive higher attention with regard to the occurrence of cardiac tamponade. Although it prolongs hospital stay, cardiac tamponade exhibits a benign clinical course without recurrence after timely intervention.
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Affiliation(s)
- Seng Chan You
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chi Young Shim
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Geu-Ru Hong
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Darae Kim
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - In Jeong Cho
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sak Lee
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyuck-Jae Chang
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong-Won Ha
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung-Chul Chang
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Namsik Chung
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Computed tomography-guided pericardiocentesis – A single-center experience. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Neves D, Silva G, Morais G, Ferreira N, Carvalho M, Gama Ribeiro V, Bettencourt N. Computed tomography-guided pericardiocentesis – A single-center experience. Rev Port Cardiol 2016; 35:285-90. [DOI: 10.1016/j.repc.2015.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/22/2015] [Indexed: 11/27/2022] Open
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Uzun K, Günaydın ZY, Tataroǧlu C, Bektaş O. The preventive role of the posterior pericardial window in the development of late cardiac tamponade following heart valve surgery. Interact Cardiovasc Thorac Surg 2016; 22:641-6. [PMID: 26819273 DOI: 10.1093/icvts/ivv390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 12/11/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES It is reported that creating a window from the posterior pericardium into the left pleural cavity during coronary bypass surgeries reduces postoperative late cardiac tamponades. Although late tamponades are more common after heart valve surgeries, this procedure is not generally performed. The present study investigated whether creating a window has a preventive effect on the formation of late cardiac tamponade after heart valve surgeries. METHODS The study was conducted on all patients (n = 262) in whom one or more valves were replaced and who fulfilled the study criteria between January 2010 and October 2014 in one centre. We began to create a posterior pericardial window in all valvular patients from March 2012. One hundred and thirty-five patients operated on before this date (Non-Window Group) and 127 patients after this date (Window Group) were compared for the development of late cardiac tamponade. RESULTS There were no differences between the groups in terms of preoperative and intraoperative characteristics. Late pericardial tamponade was not observed in any patients from the Window Group, whereas it occurred in 7 (5.2%) patients from the Non-Window Group (P = 0.015). Three patients died in total; all 3 were from the Non-Window Group. One of the mortalities was associated with tamponade. CONCLUSIONS Creating a pericardial window may reduce late cardiac tamponade events/episodes, which may be a fatal complication in valve patients. We recommend performing this procedure by allocating some time during the surgical procedure in order to avoid tamponade.
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Affiliation(s)
- Kemal Uzun
- Department of Cardiovascular Surgery, Faculty of Medicine, Ordu University, Ordu, Turkey
| | | | - Cenk Tataroǧlu
- Department of Cardiovascular Surgery, Özel Avrupa Safak Hospital, Istanbul, Turkey
| | - Osman Bektaş
- Department of Cardiology, Faculty of Medicine, Ordu University, Ordu, Turkey
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44
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The Pericardium and Its Diseases. Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00015-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Meurin P, Lelay-Kubas S, Pierre B, Pereira H, Pavy B, Iliou MC, Bussiere JL, Weber H, Beugin JP, Farrokhi T, Bellemain-Appaix A, Briota L, Tabet JY. Colchicine for Post-Operative Pericardial Effusion. J Am Coll Cardiol 2015; 66:1198-9. [DOI: 10.1016/j.jacc.2015.05.078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 04/24/2015] [Accepted: 05/05/2015] [Indexed: 11/29/2022]
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47
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Li H, Gordon SM, Zhu X, Deng J, Swertfeger DK, Davidson WS, Lu LJ. Network-Based Analysis on Orthogonal Separation of Human Plasma Uncovers Distinct High Density Lipoprotein Complexes. J Proteome Res 2015; 14:3082-94. [PMID: 26057100 DOI: 10.1021/acs.jproteome.5b00419] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
High density lipoprotein (HDL) particles are blood-borne complexes whose plasma levels have been associated with protection from cardiovascular disease (CVD). Recent studies have demonstrated the existence of distinct HDL subspecies; however, these have been difficult to isolate and characterize biochemically. Here, we present the first report that employs a network-based approach to systematically infer HDL subspecies. Healthy human plasma was separated into 58 fractions using our previously published three orthogonal chromatography techniques. Similar local migration patterns among HDL proteins were captured with a novel similarity score, and individual comigration networks were constructed for each fraction. By employing a graph mining algorithm, we identified 183 overlapped cliques, among which 38 were further selected as candidate HDL subparticles. Each of these 38 subparticles had at least two literature supports. In addition, GO function enrichment analysis showed that they were enriched with fundamental biological and CVD protective functions. Furthermore, gene knockout experiments in mouse model supported the validity of these subparticles related to three apolipoproteins. Finally, analysis of an apoA-I deficient human patient's plasma provided additional support for apoA-I related complexes. Further biochemical characterization of these putative subspecies may facilitate the mechanistic research of CVD and guide targeted therapeutics aimed at its mitigation.
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Affiliation(s)
- Hailong Li
- §Institute for Systems Biology, Jianghan University, Wuhan, Hubei, 430056, P.R. China.,†Division of Biomedical Informatics, Cincinnati Children's Hospital Research Foundation, 3333 Burnet Avenue, MLC 7024, Cincinnati, Ohio 45229-3039, United States
| | - Scott M Gordon
- ‡Center for Lipid and Arteriosclerosis Science, Department of Pathology and Laboratory Medicine, University of Cincinnati, 2120 East Galbraith Road, Cincinnati, Ohio 45237-0507, United States
| | - Xiaoting Zhu
- †Division of Biomedical Informatics, Cincinnati Children's Hospital Research Foundation, 3333 Burnet Avenue, MLC 7024, Cincinnati, Ohio 45229-3039, United States
| | - Jingyuan Deng
- †Division of Biomedical Informatics, Cincinnati Children's Hospital Research Foundation, 3333 Burnet Avenue, MLC 7024, Cincinnati, Ohio 45229-3039, United States
| | - Debi K Swertfeger
- †Division of Biomedical Informatics, Cincinnati Children's Hospital Research Foundation, 3333 Burnet Avenue, MLC 7024, Cincinnati, Ohio 45229-3039, United States
| | - W Sean Davidson
- ‡Center for Lipid and Arteriosclerosis Science, Department of Pathology and Laboratory Medicine, University of Cincinnati, 2120 East Galbraith Road, Cincinnati, Ohio 45237-0507, United States
| | - L Jason Lu
- †Division of Biomedical Informatics, Cincinnati Children's Hospital Research Foundation, 3333 Burnet Avenue, MLC 7024, Cincinnati, Ohio 45229-3039, United States
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48
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Meurin P, Lelay-Kubas S, Pierre B, Pereira H, Pavy B, Iliou MC, Bussière JL, Weber H, Beugin JP, Farrokhi T, Bellemain-Appaix A, Briota L, Tabet JY. Colchicine for postoperative pericardial effusion: a multicentre, double-blind, randomised controlled trial. Heart 2015; 101:1711-6. [PMID: 26076938 DOI: 10.1136/heartjnl-2015-307827] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/24/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Pericardial effusion is common after cardiac surgery. Growing evidence suggests that colchicine may be useful for acute pericarditis, but its efficacy in reducing pericardial effusion volume postoperatively has not been assessed. METHODS This randomised, double-blind, placebo-controlled study conducted in 10 centres in France included 197 patients at high risk of tamponade (ie, with moderate to large-sized persistent effusion (echocardiography grades 2, 3 or 4 on a scale of 0-4)) at 7-30 days after cardiac surgery. Patients were randomly assigned to receive colchicine, 1 mg daily (n=98), or a matching placebo (n=99). The main end point was change in pericardial effusion grade after 14-day treatment. Secondary end points included frequency of late cardiac tamponade. RESULTS The placebo and the colchicine groups showed a similar mean baseline pericardial effusion grade (2.9±0.8 vs 3.0±0.8) and similar mean decrease from baseline after treatment (-1.1±1.3 vs -1.3±1.3 grades). The mean difference in grade decrease between groups was -0.19 (95% CI -0.55 to 0.16, p=0.23). In total, 13 cases of cardiac tamponade occurred during the 14-day treatment (7 and 6 in the placebo and colchicine groups, respectively; p=0.80). At 6-month follow-up, all patients were alive and had undergone a total of 22 (11%) drainages: 14 in the placebo group and 8 in the colchicine group (p=0.20). CONCLUSIONS In patients with pericardial effusion after cardiac surgery, colchicine administration does not reduce the effusion volume or prevent late cardiac tamponade. CLINICAL TRIAL REG NO NCT01266694.
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Affiliation(s)
- P Meurin
- Department of Cardiology, Les Grands Prés (CRCB), Villeneuve St Denis, France
| | - S Lelay-Kubas
- Centre de Réadaptation Bois Gibert, Ballan Mire, France
| | | | - H Pereira
- Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, Paris, France INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, Paris, France
| | - B Pavy
- Centre Hospitalier Loire Vendée Océan, Machecoul, France
| | - M C Iliou
- Corentin-Celton Hospital, Issy Les Moulineaux, France
| | | | - H Weber
- Department of Cardiology, Les Grands Prés (CRCB), Villeneuve St Denis, France
| | - J P Beugin
- Clinique de la Mitterie 195 rue Adolphe Defrenne, Lomme, France
| | - T Farrokhi
- Bligny Hospital, Briis-sous-Forges, France
| | | | - L Briota
- Centre Dieuleufit santé, Dieulefit, France
| | - J Y Tabet
- Department of Cardiology, Les Grands Prés (CRCB), Villeneuve St Denis, France Private Hospital Jacques Cartier, Institut cardiovasculaire Paris Sud, Massy, France
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Treskatsch S, Balzer F, Knebel F, Habicher M, Braun JP, Kastrup M, Grubitzsch H, Wernecke KD, Spies C, Sander M. Feasibility and influence of hTEE monitoring on postoperative management in cardiac surgery patients. Int J Cardiovasc Imaging 2015; 31:1327-35. [PMID: 26047772 DOI: 10.1007/s10554-015-0689-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/01/2015] [Indexed: 01/20/2023]
Abstract
Monoplane hemodynamic TEE (hTEE) monitoring (ImaCor(®) ClariTEE(®)) might be a useful alternative to continuously evaluate cardiovascular function and we aimed to investigate the feasibility and influence of hTEE monitoring on postoperative management in cardiac surgery patients. After IRB approval we reviewed the electronic data of cardiac surgery patients admitted to our intensive care between 01/01/2012 and 30/06/2013 in a case-controlled matched-pairs design. Patients were eligible for the study when they presented a sustained hemodynamic instability postoperatively with the clinical need of an extended hemodynamic monitoring: (a) hTEE (hTEE group, n = 18), or (b) transpulmonary thermodilution (control group, n = 18). hTEE was performed by ICU residents after receiving an approximately 6-h hTEE training session. For hTEE guided hemodynamic optimization an institutional algorithm was used. The hTEE probe was blindly inserted at the first attempt in all patients and image quality was at least judged to be adequate. The frequency of hemodynamic examinations was higher (ten complete hTEE examinations every 2.6 h) in contrast to the control group (one examination every 8 h). hTEE findings, including five unexpected right heart failure and one pericardial tamponade, led to a change of current therapy in 89% of patients. The cumulative dose of epinephrine was significantly reduced (p = 0.034) and levosimendan administration was significantly increased (p = 0.047) in the hTEE group. hTEE was non-inferior to the control group in guiding norepinephrine treatment (p = 0.038). hTEE monitoring performed by ICU residents was feasible and beneficially influenced the postoperative management of cardiac surgery patients.
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Affiliation(s)
- S Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - F Balzer
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - F Knebel
- Department of Cardiology, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Habicher
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - J P Braun
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Klinikum Hildesheim GmbH, Hildesheim, Germany
| | - M Kastrup
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - H Grubitzsch
- Department of Cardiovascular Surgery, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - C Spies
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - M Sander
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Cosyns B, Plein S, Nihoyanopoulos P, Smiseth O, Achenbach S, Andrade MJ, Pepi M, Ristic A, Imazio M, Paelinck B, Lancellotti P. European Association of Cardiovascular Imaging (EACVI) position paper: Multimodality imaging in pericardial disease. Eur Heart J Cardiovasc Imaging 2014; 16:12-31. [PMID: 25248336 DOI: 10.1093/ehjci/jeu128] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Although pericardial diseases are common in the daily clinical practice and can result in a significant morbidity and mortality, imaging of patients with suspected or known pericardial disorders remain challenging. Multimodality imaging is part of the management of pericardial diseases. Echocardiography, cardiac computed tomography, and cardiovascular magnetic resonance are often used as complementary imaging modalities. The choice of one or multiple imaging modalities is driven by the clinical context or conditions of the patient. The scope of the present document is to highlight the respective role of each technique according to the clinical context in the diagnosis and management of pericardial diseases.
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Affiliation(s)
- Bernard Cosyns
- Department of Cardiology, Universtair Ziekenhuis Brussel, Centrum Voor Hart-en Vaatziekten and CHIREC, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Sven Plein
- The Division of Cardiovascular and Diabetes Research, Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
| | - Petros Nihoyanopoulos
- Department of Cardiology, Imperial College, NHLI Hammersmith Hospital London, London, UK
| | - Otto Smiseth
- Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
| | - Stephan Achenbach
- Department of Cardiology, University Hospital Erlangen, Medizinische Klinik 2, Erlangen, Germany
| | - Maria Joao Andrade
- Department of Cardiology, Hospital Santa Cruz, Instituto Cardiovascular de Lisboa, Lisboa, Portugal
| | - Mauro Pepi
- Department of Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Arsen Ristic
- Department of Cardiology, Clinical Center of Serbia, Belgrad, Serbia
| | - Massimo Imazio
- Department of Cardiology, Maria Vittoria Hospital, Turin, Italy
| | - Bernard Paelinck
- Cardiac Imaging, Department of Cardiac Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liege Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU Sart Tilman, Liege, Belgium
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