Incidence and Types of Arrhythmias After Mediastinal Manipulation During Transhiatal Esophagectomy

Malhotra, Sheetal; Kaur, Rajnish; Gupta, Nidhi; Grover, Anil; Krishnan, Ramprabu; Nakra, Dhiraj

doi:10.1016/j.athoracsur.2006.02.041

Cited by 19 publications

(11 citation statements)

References 12 publications

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“…Also, 66.7% of patients with intraoperative arrhythmias and 45.2% without arrhythmias had hypotension, which was not statistically significant (P = 0.009), indicating no correlation between arrhythmias and hypotension. This result is the same as that in the study done by Malhotra ( 11 ).…”

Section: Discussionsupporting

confidence: 92%

“…The middle esophageal lesions are mostly SCC in origin without any effect on arrhythmias. The incidence of intraoperative arrhythmias in our study was the same as that in a study by Malhotra et al (65%) ( 11 ). In our study, about 23.3% of the patients with arrhythmias and 10% without arrhythmias had blood transfusions that were statistically significant (P < 0.005), indicating prolonged manipulation in patients with bleeding.…”

Section: Discussionsupporting

confidence: 89%

“…Moreover, the patients with any coexisting cardiopulmonary disease were excluded from our study. Therefore, the arrhythmias and hypotension were exclusively due to mediastinal manipulation ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

“…Hypotension was defined as a decrease of systolic blood pressure by 20% from the baseline ( 11 ). Hypotension occurred in 8.2% of the patients in the pre-manipulation period and in 55.7% of the patients during manipulation.…”

Section: Discussionmentioning

confidence: 99%

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RETRACTED ARTICLE: Incidence and Risk Factors of an Intraoperative Arrhythmia in Transhiatal Esophagectomy

Ahmadinejad

Hashemi

Tabatabai

et al. 2015

Iran Red Crescent Med J

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Background:Transhiatal esophagectomy (THE) is a widely used technique for carcinoma of the esophagus and other conditions, such as benign strictures and motility disorders.Objectives:The aim of our study was to quantify the incidence, predisposing factors, as well as types of arrhythmias in transhiatal esophagectomy.Patients and Methods:In this prospective study, we selected 61 patients undergoing transhiatal esophagectomy during 2012 - 2013 in our hospital. The demographic information, site of the tumor, cardiopulmonary function, transfusion, preoperative and postoperative complications (i.e. arrhythmias, hypotension), operation time, duration of mediastinal manipulation, amount of hemorrhage, volume loss, volume intake, mean systolic and diastolic pressure, and death rate were evaluated by chi-square, Fisher’s exact test, ANOVA, and t-tests.Results:The mean age of patients was 61.24 ± 11.48. In the study group, 8.2% of the patients before, 50.8% during, and 11.2% after mediastinal manipulation showed arrhythmia. Tumor location, the need for transfusion, pathology of the tumor, presence of arrhythmia before the operation, FEV1 (Forced Expiratory Volume) > 2 liters, and mean volume intake were significantly different between the patients with and without arrhythmia. Hypotension was shown in 8.2% of the patients before and 57.7% during mediastinal manipulation. Manipulation times, volume loss, mean systolic and diastolic blood pressure before the operation, and FEV1 > 2 liters were statistically significant in occurrence of hypotension.Conclusions:Our data showed that the amount of hydration, transfusion, pre-manipulation arrhythmia, and pulmonary function should be controlled to decrease the risk of arrhythmias. Minor mediastinal manipulation, few intraoperative hemorrhages, improvement of pulmonary function, and careful blood pressure monitoring can reduce the risk of hypotension.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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RETRACTED ARTICLE: Incidence and Risk Factors of an Intraoperative Arrhythmia in Transhiatal Esophagectomy

Ahmadinejad

Hashemi

Tabatabai

et al. 2015

Iran Red Crescent Med J

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“…The potential explanation for these events could be the autonomic instability arising due to the proximity of the vagal and sympathetic nerves to the site of the repositioned stomach in posterior mediastinum, direct manipulation of atrium or pericardium during mediastinal dissection and manipulation, and postoperative hyper adrenergic state. [ 13 18 19 ] In adult patients undergoing trans-hiatal esophagectomy, a high incidence of arrhythmias (up to 50%) was reported during the phase of mediastinal manipulation, however they were transient and associated simultaneously with hypotension due to impaired cardiac filling. [ 20 21 ] In pediatric patients undergoing posterior mediastinal GPU, tachycardia or tachyarrhythmias may persist into postoperative period and may be associated with hypertension as observed in two of our cases.…”

Section: Discussionmentioning

confidence: 99%

Pediatric esophageal substitution by gastric pull-up and gastric tube

Choudhury

Yadav

Khan

et al. 2016

J Indian Assoc Pediatr Surg

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Aim:The aim of this study was to report the results of pediatric esophageal substitution by gastric pull-up (GPU) and gastric tube (GT) from a tertiary care pediatric center.Materials and Methods:Retrospective analysis of the surgical techniques, results, complications, and final outcome of all pediatric patients who underwent esophageal substitution in a single institution was performed.Results:Twenty-four esophageal substitutions were performed over 15-year period. The indications were pure esophageal atresia (EA)-19, EA with distal trachea-esophageal fistula-2, EA with proximal pouch fistula-1, and esophageal stricture in two patients. Mean age and weight at operation were 17 months and 9.5 kg, respectively. GPU was the most common procedure (19) followed by reverse GT (4) and gastric fundal tube (1). Posterior mediastinal and retrosternal routes were used in 17 and 7 cases, respectively. Major complications included three deaths in GPU cases resulting from postoperative tachyarrhythmias leading to cardiac arrest, cervical anastomotic leak-17, and anastomotic stricture in six cases. Perioperative tachyarrhythmias (10/19) and transient hypertension (2/19) were observed in GPU patients, and they were managed with beta blocker drugs. Postoperative ventilation in Intensive Care Unit was performed for all GPU, but none of the GT patients. Follow-up ranged from 6 months to 15 years that showed short-term feeding difficulties and no major growth-related problems.Conclusions:Perioperative tachyarrhythmias are common following GPU which mandates close intensive care monitoring with ventilation and judicious use of beta blocking drugs. Retrosternal GT with a staged neck anastomosis can be performed without postoperative ventilation.

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Meta-analysis of risk factors and complications associated with atrial fibrillation after oesophagectomy

Schizas

Kosmopoulos

Giannopoulos

et al. 2019

British Journal of Surgery

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Background: Oesophagectomy is associated with high morbidity and mortality rates. New-onset atrial fibrillation (AF) is a frequent complication following oesophagectomy. Several studies have explored whether new-onset AF is associated with adverse events after oesophagectomy.Methods: This review was performed according to PRISMA guidelines. Eligible studies were identified through a search of PubMed, Scopus and Cochrane CENTRAL databases up to 25 November 2018. A meta-analysis was conducted with the use of random-effects modelling. The I 2 statistic was used to assess for heterogeneity.Results: In total, 53 studies including 9087 patients were eligible for analysis. The overall incidence of postoperative AF was 16⋅5 per cent. Coronary artery disease and hypertension were associated with AF, whereas diabetes, smoking and chronic obstructive pulmonary disease were not. Patients with AF had a significantly higher risk of overall postoperative adverse events than those without fibrillation (odds ratio (OR) 5⋅50, 95 per cent c.i. 3⋅51 to 8⋅30), including 30-day mortality (OR 2⋅49, 1⋅70 to 3⋅64), anastomotic leak (OR 2⋅65, 1⋅53 to 4⋅59) and pneumonia (OR 3⋅42, 2⋅39 to 4⋅90).Conclusion: Postoperative AF is frequently observed in patients undergoing oesophagectomy for cancer. It is associated with an increased risk of death and postoperative complications.

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Incidence and Types of Arrhythmias After Mediastinal Manipulation During Transhiatal Esophagectomy

Cited by 19 publications

References 12 publications

RETRACTED ARTICLE: Incidence and Risk Factors of an Intraoperative Arrhythmia in Transhiatal Esophagectomy

RETRACTED ARTICLE: Incidence and Risk Factors of an Intraoperative Arrhythmia in Transhiatal Esophagectomy

Pediatric esophageal substitution by gastric pull-up and gastric tube

Meta-analysis of risk factors and complications associated with atrial fibrillation after oesophagectomy

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