Predictors of temporary epicardial pacing wires use after valve surgery

AlWaqfi, Nizar R.; Ibrahim, Khalid S.; Khader, Yousef; Baker, Ahmad Abu

doi:10.1186/1749-8090-9-33

Cited by 20 publications

(19 citation statements)

References 29 publications

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“…Although need of EPW can be questioned in selected cases, i.e. low-risk aortic valve replacement [6–8], presence of these wires can be very helpful in weaning from cardiopulmonary bypass or improving cardiac output in the early postoperative period [9]. …”

Section: Discussionmentioning

confidence: 99%

Is there a correlation between late re-exploration after cardiac surgery and removal of epicardial pacemaker wires?

Bougioukas

Jebran

Grossmann

et al. 2017

J Cardiothorac Surg

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BackgroundRe-exploration for bleeding accounts for increased morbidity and mortality after major cardiac operations. The use of temporary epicardial pacemaker wires is a common procedure at many departments. The removal of these wires postoperatively can potentially lead to a serious bleeding necessitating intervention.MethodsFrom Jan 2011 till Dec 2015 a total of 4244 major cardiac procedures were carried out at our department. We used temporary epicardial pacemaker wires in all cases. We collected all re-explorations for bleeding and pericardial tamponade from our surgical database and then we focused on the late re-explorations, meaning on the 4th postoperative day and thereafter, trying to identify the removal of the temporary pacemaker wires as the definite cause of bleeding. Patients’ records and medication were examined.ResultsThirty-nine late re-explorations for bleeding, consisting of repeat sternotomies, thoracotomies and subxiphoid pericardial drainages, were gathered. Eight patients had an acute bleeding incidence after removal of the temporary wires (0.18%). In four of these patients, a pericardial drainage was inserted, whereas the remaining patients were re-explorated through a repeat sternotomy. Two patients died of the acute pericardial tamponade, three had a blood transfusion and one had a wound infection. Seven out of eight patients were either on dual antiplatelet therapy or on combination of aspirin and vitamin K antagonist.ConclusionsA need for re-exploration due to removal of the temporary pacemaker wires is a very rare complication, which however increases morbidity and mortality. Adjustment of the postoperative anticoagulation therapy at the time of removal of the wires could further minimize or even prevent this serious complication.

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Section: Discussionmentioning

confidence: 99%

Is there a correlation between late re-exploration after cardiac surgery and removal of epicardial pacemaker wires?

Bougioukas

Jebran

Grossmann

et al. 2017

J Cardiothorac Surg

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“…Other studies have identified age, 10‐13 preoperative arrhythmia, 10,11,13 diabetes, 13 higher NYHA class, 12 high pulmonary pressures, 12 certain medications, 11,12 certain types of valve surgery, 11,12 heavy annular calcification, 12 longer cross‐clamp time, 12 and pacing on separation of CPB 10,13 as predictors of TEPW need. While there are some variability in findings, in general older, more comorbid patients are more likely to require pacing following cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

“…They also found selective placement of TEPW was safe, with 42% of patients not receiving TEPW. They had no negative consequences with this selective placement strategy 12 . In our study, we examined isolated patients with AVR which has not been done previously.…”

Section: Discussionmentioning

confidence: 99%

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Prediction of temporary epicardial pacing wire use in cardiac surgery

et al. 2020

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Background Placement of temporary epicardial pacing wires (TEPW) at the end of open heart surgery cases is routine but can be associated with complications. Identification of patients who are high risk for requiring pacing would be beneficial on guiding selective TEPW placement. The purpose of this study was to identify predictors of temporary pacing immediately post cardiac surgery. Methods A retrospective analysis of patients undergoing cardiac surgery from 2005 to 2016 at the Maritime Heart Center was conducted. Analysis was performed of patients who require pacing on arrival to the cardiovascular intensive care unit (CVICU) compared with those who were not paced. Multivariable logistic regression was used to determine each variable's risk adjusted likelihood of pacing for the entire cohort. Subgroup analysis was performed in the isolated procedures. Results A total of 11 752 patient underwent surgery from the year 2005 to 2016. Two thousand and fifty‐one (17.5%) required pacing on arrival to CVICU. Older age, female sex, preoperative renal failure, lower ejection fraction (EF), preoperative arrhythmia, preoperative use of calcium channel blockers, and longer cross‐clamp times were risk factors for pacing. In the isolated coronary artery bypass grafting and aortic valve replacement groups, findings were similar to the overall cohort. Only age, obesity, and chronic obstructive pulmonary disease were risk factors for pacing in the isolated mitral valve (MV) repair group and only preoperative arrhythmia in the isolated MV replacement group. Conclusion We have identified risk factors for TEPW use following cardiac surgery and in isolated procedure subgroups. These risk factors may help guide selective TEPW placement.

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“…There are multiple means by which wires may be affixed to the right atrium including direct suture or clipping, or through the use of an atrial button. Previous investigators have demonstrated that numerous patient factors may be associated with the subsequent need for temporary pacing such as advanced age, NYHA III-IV, pulmonary hypertension, digoxin use, multiple valvular replacement, long cross-clamp time and annular calcification [ 4 ]. In the majority of cases, pacer wires are not used and in fact, some surgical groups have recommended more selective insertion, particularly with low-risk surgery such as elective off-pump coronary bypass grafting [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical and mechanical factors associated with the removal of temporary epicardial pacemaker wires after cardiac surgery

Elmistekawy

Gee

Une

et al. 2016

J Cardiothorac Surg

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BackgroundTemporary pacemaker wires are placed in the majority of patients after cardiac surgery. There is no information on mechanical factors related to wire removal.MethodsClinical information related to temporary wire use and removal was prospectively collected from a large cardiac surgical unit over one year. Measurements of maximal tension that nurses and doctors would apply to remove temporary wires was determined using a hand-held portable scale. In a prospective trial, patients (n = 41) had their wires extracted in series to the portable scale to determine the maximal tension required for safe removal.ResultsVentricular wires were placed in 86.5 % of patients during the observed year. Pacing facilitated weaning from CPB in over 15 % of patients and pacer dependence was seen in 2.1 %. No patients suffered major complications after wire removal. There was no difference in the tension that physicians or nurses would apply to comfortably extract temporary wires. In the prospective trial, there was no difference in the tension required for removal of atrial or ventricular wires (atrial 18.3 ± 17.9 oz versus 14.5 ± 14.2 oz, p = 0.430). There were no patient factors that correlated with the degree of resistance and there was no significant difference between the tension required to remove wires with (21.0 ± 22.5 oz) or without (14.1 ± 5.1 oz) an atrial button.ConclusionsTemporary epicardial wire removal is innocuous and was not associated with any complications. In some patients tension required for safe removal exceeded 20 ounces. Strategies to standardize wire removal may prevent complications and may minimize unnecessary wire retention.

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Predictors of temporary epicardial pacing wires use after valve surgery

Cited by 20 publications

References 29 publications

Is there a correlation between late re-exploration after cardiac surgery and removal of epicardial pacemaker wires?

Is there a correlation between late re-exploration after cardiac surgery and removal of epicardial pacemaker wires?

Prediction of temporary epicardial pacing wire use in cardiac surgery

Clinical and mechanical factors associated with the removal of temporary epicardial pacemaker wires after cardiac surgery

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