Thoracoscopic versus subxiphoid pericardial window in patients with end-stage renal disease

Salim, Ehab F.; Rezk, Moataz E.

doi:10.1016/j.jescts.2018.07.002

Cited by 3 publications

(2 citation statements)

References 12 publications

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“…21,22) A small study by Salim and colleagues reported that VATS decreased the total length of hospital stay and the recurrence of pericardial effusion compared with the subxiphoid approach. 23) Several limitations to this study should be considered. The relatively small sample size and lack of a control group represent an important limitation.…”

Section: Discussionmentioning

confidence: 96%

Video-Assisted Thoracoscopic Surgery Management of Subacute Retained Blood Syndrome after Cardiac Surgery

Drosos

Durak

Autschbach

et al. 2022

ATCS

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loss leads to a broad spectrum of complications, from acute cardiac tamponade to subacute hemothorax. Boyle et al. described the need for new labels for post-surgical bleeding, including the acute, subacute, and chronic phases of bleeding, and proposed the term retained blood syndrome (RBS).3) The incidence of RBS is 13.8%-22.7% after cardiac surgery. 3) In acute RBS, early exploration within the first 48 postoperative hours via an emergency re-sternotomy is the gold standard. In subacute RBS (>48 hr), the remaining clots activate inflammatory mechanisms that cause increased postoperative atrial fibrillation, in-hospital mortality, and longer in-hospital stays. 4) In addition, a large number of clots cause mechanical compression of the lung and severe atelectasis. Furthermore, clot contamination can lead to pleural empyema. 5) Despite the consequences, proper management of subacute Purpose: Blood loss along with inadequate evacuation after cardiac surgery leads to retained blood syndrome (RBS) in the pleural and/or pericardial cavity. Re-sternotomy is often needed for clot evacuation. Video-assisted thoracoscopic surgery (VATS) evacuation is a less-invasive procedure. However, sufficient evidence on safety and outcomes is lacking. Methods: Thirty patients who developed hemothorax and/or hemopericardium after cardiac surgery and underwent VATS evacuation between April 2015 and September 2020 were included in this retrospective single-center analysis. Results: The median patient age was 70 (interquartile range: IQR 62-75) years, body mass index (BMI) was 24.7 (IQR 22.8-29) kg/m 2 , time between initial cardiac surgery and VATS was 17 (IQR 11-21) days, 30% of the patients were female, 60% resided in the ICU, and 17% were nicotine users. Coronary artery bypass graft was the most frequent initial cardiac procedure. Median operation time was 120 (IQR 90-143) min, 23% of the patients needed an additional VATS, and the median length of hospital stay after VATS was 8 (IQR 5-14) days. All patients survived VATS, and we experienced no mortality related to the VATS procedure. Conclusion: In our study, VATS for evacuation of RBS after cardiac surgery was a feasible, safe, and efficient alternative approach to re-sternotomy in selected patients.

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Section: Discussionmentioning

confidence: 96%

Video-Assisted Thoracoscopic Surgery Management of Subacute Retained Blood Syndrome after Cardiac Surgery

Drosos

Durak

Autschbach

et al. 2022

ATCS

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“…[ 3 ] The subxiphoid approach creates an external communication only and should not be called a ‘window’ procedure as it does not create a communication between the pericardial and pleural cavities. [ 4 ] PW by anterolateral thoracotomy provides excellent drainage but, at the cost of a large and traumatic incision, a high price to pay just for access in these sick patients. On the other hand, thoracoscopic PW procedure creates a good-sized communication between the pericardial and pleural cavities in a minimally invasive manner, without the disadvantages of thoracotomy.…”

Section: Introductionmentioning

confidence: 99%

Safety and feasibility of thoracoscopic pericardial window in recurrent pericardial effusion – A single-centre experience

Kumar¹,

Pulle²,

Bansal³

et al. 2022

Journal of Minimal Access Surgery

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Background: This study aimed to report the surgical outcomes and also evaluating the safety and feasibility of thoracoscopic pericardial window (PW) for recurrent pericardial effusion. Materials and Methods: This was a retrospective analysis of eight cases of recurrent pericardial effusion, managed by thoracoscopic method in a tertiary-level thoracic surgery centre over 5 years. A detailed analysis of all perioperative variables, including complications, was carried out. Results: A total of eight patients underwent thoracoscopic PW during the study period. Males (87.5%) were predominant in the cohort. The median age was 54 years (range: 28–78 years). The median duration of symptoms was 2 months (range: 1–3 months). Tuberculosis (50%), malignancy (37.5%) and chronic kidney disease (12.5%) were the causes of recurrent effusion. All patients underwent thoracoscopic procedure with no conversions. The median operative time was 45 min (range: 40–70 min). The median effusion volume drained was 500 ± 100 ml. The median hospital stay was 3 days (range: 2–4 days) with no post-procedural complications. All the patients had complete resolution of symptoms. No recurrence was noted in the median follow-up period of 28 months (range: 6–60 months). Conclusions: Thoracoscopic PW is a safe and feasible minimally invasive option in the management of recurrent pericardial effusion in selected patients. Surgical fitness, haemodynamic status and estimated survival (in malignant effusion) should be considered before the procedure.

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Laparoscopic transdiaphragmatic pericardial fenestration in palliative care: how I do it

Haes

Zimmerman

Özmen

et al. 2020

Acta Chirurgica Belgica

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Thoracoscopic versus subxiphoid pericardial window in patients with end-stage renal disease

Cited by 3 publications

References 12 publications

Video-Assisted Thoracoscopic Surgery Management of Subacute Retained Blood Syndrome after Cardiac Surgery

Video-Assisted Thoracoscopic Surgery Management of Subacute Retained Blood Syndrome after Cardiac Surgery

Safety and feasibility of thoracoscopic pericardial window in recurrent pericardial effusion – A single-centre experience

Laparoscopic transdiaphragmatic pericardial fenestration in palliative care: how I do it

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