Pleural Effusion After Ventricular Assist Device Placement

Guha, Ashrith; Munjampalli, Sai; Bandi, Venkata; Loebe, Matthias; Noon, George P.; Lunn, William

doi:10.1378/chest.07-2777

Cited by 7 publications

(11 citation statements)

References 23 publications

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“…Early effusions are typically bloody, inflammatory, and exudative, suggesting that retained blood may be a contributing factor. 19,20 These data suggest that by having more complete drainage in the acute phase of chest tube drainage with ATC, we had to reinsert fewer chest tubes postoperatively less often. The number of patients having thoracentesis and pericardiocentesis were too small for statistical comparison.…”

Section: Discussionmentioning

confidence: 98%

Active Clearance of Chest Tubes Reduces Re-Exploration for Bleeding After Ventricular Assist Device Implantation

et al. 2016

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Chest tubes are utilized to evacuate shed blood after left ventricular assist device (LVAD) implantation, however, they can become clogged, leading to retained blood. We implemented a protocol for active tube clearance (ATC) of chest tubes to determine if this might reduce interventions for retained blood. A total of 252 patients underwent LVAD implantation. Seventy-seven patients had conventional chest tube drainage (group 1), whereas 175 patients had ATC (group 2). A univariate and multivariate analysis adjusting for the use of conventional sternotomy (CS) and minimally invasive left thoracotomy (MILT) was performed. Univariate analysis revealed a 65% reduction in re-exploration (43–15%, p < 0.001), and an 82% reduction in delayed sternal closure (DSC; 34–6%, p <0.001). In a sub-analysis of CS only, there continued to be statistically significant 53% reduction in re-exploration (45% vs. 21%, p = 0.0011), and a 77% reduction in DSC (35% vs. 8%, p < 0.001) in group 2. Using a logistic regression model adjusting for CS versus MILT, there was a significant reduction in re-exploration (odds ratio [OR] = 0.44 [confidence interval {CI} = 0.23–0.85], p = 0.014) and DSC (OR = 0.20 [CI = 0.08–0.46], p <0.001) in group 2. Actively maintaining chest tube patency after LVAD implantation significantly reduces re-exploration and DSC.

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Section: Discussionmentioning

confidence: 98%

Active Clearance of Chest Tubes Reduces Re-Exploration for Bleeding After Ventricular Assist Device Implantation

et al. 2016

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“…PEs commonly occur in patients shortly after ventricular assist device implantation [ 9 , 10 ] or postcardiac injury syndrome after defibrillator implantation, [ 11 ] and generally, samples of PEs are exudative in nature. PEs may also be associated with pacemaker placement; patients who experience this may have rapid or slow accumulation and reaccumulation of fluid within the pleural space.…”

Section: Discussionmentioning

confidence: 99%

Recurrent, late-onset pleural effusions in elderly patients receiving pacemaker therapy

Xiong

Zhang²,

Hu³

et al. 2018

Medicine

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Late-onset pacemaker-related pleural effusions (PEs) are rare and are often misdiagnosed with other entities. Our study aimed to detail the clinical features and management of PEs long after pacemaker insertion.We conducted a review of 6 consecutive elderly patients with PEs, who had undergone a new pacemaker insertion from September 2014 to January 2017. Also, the clinical characteristics and therapeutic courses of PEs were summarized.Two cases involved fluids after the first implantations, with pacing durations of 3 and 7 months. Two other cases developed PEs 3 or 4 months after the first replacement, with pacing durations of 6 and 11 years. Another 2 cases developed PEs 3 or 5 months following the second replacement, with total pacing durations of 16 and 18 years, respectively. The average interval was 4.17 months for the 6 cases from the time of the new pacemaker insertion to the occurrence of PEs. During the course, they had to be hospitalized repeatedly for thoracenteses because conventional treatments had only short-term effects. After the pacing settings were adjusted, PEs in all cases disappeared gradually. No patients were readmitted for PEs during the median follow-up period of 13 months.For elderly patients following implantation of a new pacemaker, PEs should be considered due to improper pacing settings, and corresponding adjustments to the device should be made.

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“…Despite encouraging survival data in VAD recipients, many of these patients experience significant post-operative complications, including pleural and/or pericardial effusions [1,2]. There is limited scientific literature on the outcomes of the operative drainage of pleural and pericardial effusions after VAD implantation [5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…The use of minimally invasive surgery to address symptomatic pleural and pericardial effusions has also been a part of attempts to prevent driveline infection. Potential advantages of VATS over open surgery include decreased exposure of the drivelines to the ambient environment (10 mm port sites versus larger open incision) and decreased immunosuppression as a result of diminished surgical trauma [2,10,11].…”

Section: Discussionmentioning

confidence: 99%

“…Major perioperative complications are frequent in patients with ventricular assist devices (VADs) and include bleeding, stroke, sepsis and multi-organ failure [1]. In addition, patients with VADs may develop pleural and pericardial effusions requiring operative drainage [2]. The outcomes of these procedures are not well established in this patient population.…”

Section: Introductionmentioning

confidence: 99%

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Minimally invasive approach to thoracic effusions in patients with ventricular assist devices

Gilbert

Kilic

Yaeger

et al. 2011

Interactive CardioVascular and Thoracic Surgery

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The aim of this study was to compare our experience between open and video-assisted thoracic surgery (VATS) approaches to the management of thoracic effusions in ventricular assist device (VAD) patients. This was a retrospective review of a prospectively collected database of VAD patients at a single institution. Patients who were operated on for pericardial and/or pleural effusions were included. Primary outcomes included operative mortality and morbidity as well as effusion recurrence. From 1993 to 2009, 360 adult patients underwent VAD placement. Twenty-three patients (11.9%) required operative management of pleural (n = 24), pericardial (n = 13) or both pleural and pericardial (n = 6) effusions [open = 20 (47%); VATS = 23 (53%)]. Drainage with decortication was performed in five patients, with the remaining undergoing drainage alone. Open and VATS patients were similar in age, gender and indication for VAD support. Conversion from VATS to open was necessary in four patients (17%). There was no operative mortality and no difference in perioperative complications between approaches. The open and VATS approaches had similar rates of pleural (open = 63%; VATS = 41%; P = 0.42) and pericardial (open = 31%; VATS = 17%; P = 1) effusion recurrences. In spite of apparent challenges, the VATS approach may be as safe and effective as open surgery for the management of pleural and pericardial effusions in VAD patients in centres with significant minimally invasive thoracic experience.

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Pleural Effusion After Ventricular Assist Device Placement

Cited by 7 publications

References 23 publications

Active Clearance of Chest Tubes Reduces Re-Exploration for Bleeding After Ventricular Assist Device Implantation

Active Clearance of Chest Tubes Reduces Re-Exploration for Bleeding After Ventricular Assist Device Implantation

Recurrent, late-onset pleural effusions in elderly patients receiving pacemaker therapy

Minimally invasive approach to thoracic effusions in patients with ventricular assist devices

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