Prevalence of symptomatic large pleural effusions first diagnosed more than 30 days after coronary artery bypass graft surgery

Peng, Ming-Cheng; Hou, Charles Jia‐Yin; Li, Jiun-Yi; Hu, Po-Yuan; Chen, Chun‐Yen

doi:10.1111/j.1440-1843.2006.00972.x

Cited by 18 publications

(21 citation statements)

References 6 publications

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“…Morbidity and mortality rates were 17.6% and 0%, respectively, with the most common morbidity being congestive heart failure, transient ischemic attack, and atrial fibrillation. Peng et al (8) found 11/356 (3%) symptomatic post-CABG PEs. Late PEs (n=6) compared to early PE (n=5) had lower levels of LDH and lower ejection fraction, supporting congestive heart failure as aetiology.…”

Section: Resultsmentioning

confidence: 98%

“…The present review included two case-series study including ≥4 patients (2,5), 7 retrospective analytical studies (3,4,(7)(8)(9)(10)(11), and one observational study (6) but no randomized controlled trials (RCTs). The score of the level of evidence according to the criteria of Centre for Evidence Based Medicine (CEBM) (12) was low.…”

Section: Resultsmentioning

confidence: 99%

“…The score of the level of evidence according to the criteria of Centre for Evidence Based Medicine (CEBM) (12) was low. In fact, only one study presented a level of evidence of 2C (6), 7 studies a level of 3b (3,4,(7)(8)(9)(10)(11), and two studies (2,5) a level of 4.…”

Section: Resultsmentioning

confidence: 99%

“…The incidence of early PE is generally higher with use of IMA grafts compared to SVC grafts since the necessity to enter to adjacent pleura space while mobilizing and harvesting the IMA. However, two papers (6,8) found no-significant difference on the incidence of late PE between patients who received SVG plus IMA grafts, patients who received CABG with valve surgery, and patients who received only valve surgery (6,8) and between patient who received only © Journal of Thoracic Disease. All rights reserved.…”

Section: Discussionmentioning

confidence: 99%

“…The management of PE encompassed medical therapy only, thoracentesis, and/ or surgical drainage with or without decortication (2-11). Most of the authors treated early and late PE with thoracentesis or chest drainage (2,3,6,8,10,11), while VATS with pleurodesis was reserved only for patients with PE that persisted after repeating thoracentesis and/or chest drainage (5,7,9). All studies but one (8) do not include follow-up, making difficult to define the effectiveness of thoracentesis or chest drainage to resolve PE, as it remains unknown in how many patients an effusion recurs.…”

Section: Discussionmentioning

confidence: 99%

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The role of video-assisted thoracoscopic surgery for management of symptomatic pleural effusion after coronary artery bypass surgery: a best evidence topic report

et al. 2017

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A best evidence topic in thoracic surgery was written addressing whether video-assisted thoracoscopic surgery (VATS) talc pleurodesis could be justified in patients with pleural effusion (PE) after coronary artery bypass graft (CABG) surgery and no-responded to repeated thoracentesis. Ten papers were identified to answer the question. Of these, two were case-series study including ≥4 patients, 7 retrospective analytical studies, and one observational study but no randomized controlled trial (RCTs) was included in the analysis. The score of the level of evidence was low; only one study presented a level of evidence of 2, 7 studies a level of 3b; and two studies a level of evidence of 4. The incidence of symptomatic post-CABG PE ranged from 2% to 9.7%. Management strategies included medical management, thoracentesis, and/ or surgical drainage. Most of the authors treated early and late PE with thoracentesis or chest drainage, while VATS with pleurodesis was reserved only for selected patients with persistent effusion after repeating thoracentesis and/or chest drainage. All studies but one do not include follow-up, thus rendering it difficult to define the real role of thoracentesis or chest drainage as definitive treatments for effusion, given the incomplete data regarding how many patients' effusions recur. Conversely, with follow up reported, no case of recurrence was found after VATS procedure. In patients who underwent delayed VATS, it was common to identify the formation of tenacious peel that trapped the lung. In three cases conversion to thoracotomy was required to decorticate the inflammatory peel that covered the pleura and did not allow the lung reexpansion. However, only five papers showed that VATS for management of post-CABG PEs is safe and efficacious and its use could help to prevent trapped lung through the resection of adhesions and loculations sometimes associated with multiple previous thoracentesis or chest drainage. As the low grade of evidence from the present analysis, future randomized controlled studies are wanted to define the real effectiveness of VATS in this field. Clinical scenarioA 57-year-old man was referred to your attention for the management of a left-sided symptomatic pleural effusion (PE). He underwent coronary artery bypass graft (CABG) surgery with a left internal thoracic artery (LITA) graft for unstable angina three months earlier. During follow-up, he had received two thoracentesis for symptomatic left-sided PE. Despite clinical improvements, each time the effusion re-accumulated, leading to a recrudescence of the dyspnoea. In both circumstances, the effusion fluid appeared serous with lymphocyte predominance but without neoplastic cells. How should this patient be managed and treated? Should we apply chest drainage and performing through that a blind talc pleurodesis (talc slurry), leaving him at risk of pleural adhesions formation or we should directly perform a video-assisted thoracoscopic surgery (VATS) talc pleurodesis in order to reduce the risk of PE rec...

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Section: Resultsmentioning

confidence: 98%