Search

Background: Cardiac implantable electronic device (CIED) procedures are prone to complications. In our study, we investigated the effect of body mass index (BMI) on CIED‐related complications. Methods: 1676 patients who had undergone CIED surgery (de novo implantation, system upgrade, generator change, pocket revision or lead replacement) at two heart centers in Turkey and met the study criteria were included in our study. For analysis of primary and secondary endpoints, patients were classified as non‐obese (BMI < 25 kg/m2), overweight (25 ≤ BMI < 30 kg/m2), and obese (BMI ≥ 30 kg/m2). The primary endpoint was accepted as cumulative events, including the composite of clinically significant hematoma (CSH), pericardial effusion or tamponade, pneumothorax, and infection related to the device system. Secondary outcomes included each component of cumulative events. Results: The rate of cumulative events, defined as primary outcome, was higher in the obese patient group, and we found a significant difference between the groups (3.0%, 4.3%, 8.9%, p =.001). CSH and pneumothorax rates were significantly higher in the obese patient group (0.3%, 0.9%, 1.9%, p =.04; 1.0%, 1.4%, 3.3%, p =.04, respectively). According to our multivariate model analysis; gender (OR:1.882, 95%CI:1.156–3.064, p =.01), hypertension (OR:4.768, 95%CI:2.470–9.204, p <.001), BMI (OR:1.069, 95%CI:1.012–1.129, p =.01) were independent predictors of cumulative events rates. Conclusions: Periprocedural complications associated with CIED (especially hematoma and pneumothorax) are more common in the group with high BMI. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine the etiology in 100 tertiary care patients who underwent pericardiocentesis in the last 5 years due to cardiac tamponade or large pericardial effusion (floating heart) through retrospective analysis of their echocardiographic findings, biochemical and cytological test results, and imaging methods. Materials and Methods: The records of 100 patients who underwent pericardiocentesis in 2014-2019 due to pericardial effusion were reviewed retrospectively. Their etiology was determined by recording their echocardiograms, biochemical test results, imaging results, and those of laboratory tests performed on pericardial fluid, culture, and cytology results. All data of the patients were recorded and analyzed. Results: Cardiac tamponade was the most common reason (77%) for pericardiocentesis performed in the patients in the study group. Of the drained effusions, 56% were macroscopically hemorrhagic. The most common etiology was associated with idiopathic causes by 32%. Malignancy was found only in 44.6% of the hemorrhagic effusions. Cytological examination revealed 83% benign findings. Only 58.6% of the patients with malignancy were found to have malignant cells in their cytological tests. Conclusion: The most common cause was idiopathic in the patients for whom pericardiocentesis was indicated in our study group. Nearly half of the macroscopically hemorrhagic effusions had malignancy. Half of the patients who developed effusion due to malignancy were found to have malignant cells in cytological tests. This study differs from other studies conducted in Turkey because it included a higher number of patients and its results are important to guide our daily practice. [ABSTRACT FROM AUTHOR]

Echocardiography-guided pericardiocentesis is the first choice method for relieving cardiac tamponade, but the exact role of the echocardiography at the moment of the puncture is still controversial. In this report, detailed echocardiographic evaluation was performed in 21 consecutive patients with cardiac tamponade just before the pericardiocentesis. Appropriate needle position was determined according to the probe position using imaginary x, y, and z axes. Pericardiocentesis was performed successfully using this technique without simultaneous echocardiography and no complications were observed. We concluded that bedside echocardiography with detailed evaluation of the puncture site and angle is enough for pericardiocentesis instead of real time guiding. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative bleeding requires blood transfusion and surgical re-exploration that can affect the short- and long-term postoperative outcomes. Interventions that can be used in the postoperative period to reduce blood loss should be developed. Continuous postoperative pericardial flushing (CPPF) with an irrigation solution may reduce blood loss by preventing the accumulation of clots. This study examined the feasibility and acceptability of CPPF for reducing bleeding after coronary artery bypass surgery., Methods: This pilot study adopted a prospective and group comparison design. Between January and April 2018, 42 patients who underwent isolated coronary artery bypass surgery received CPPF from sternal closure up to 8 h postoperative. The mean actual blood loss in the CPPF group was compared to the mean of retrospectively group (n = 58). In the CPPF group, an extra infusion catheter was inserted through one of the tube incision holes and an irrigation solution (0.9% NaCl at 38 °C) was delivered to the pericardial cavity by using a volumetric pump. Safety aspects, feasibility issues, and complications were documented. The primary outcome was blood loss, and it was assessed 18 h after the surgery., Results: CPPF was successfully completed in 40 patients (95.24%). Method-related complications were not observed. Feasibility was good in this experimental setting. Blood loss was lower in the CPPF group (257.24 mL) than non-CPPF group (p < 0.001)., Conclusions: CPPF after coronary artery bypass grafting surgery is safe, effective, feasible, and acceptable. However, standardized randomized clinical trials are necessary to draw definitive conclusions.

Objective: Postpericardiotomy syndrome (PPS), which is thought to be related to autoimmune phenomena, represents a common postoperative complication in cardiac surgery. Late pericardial effusions after cardiac surgery are usually related to PPS and can progress to cardiac tamponade. Preventive measures can reduce postoperative morbidity and mortality related to PPS. In a previous study, diclofenac was suggested to ameliorate autoimmune diseases. The aim of this study was to determine whether postoperative use of diclofenac is effective in preventing early PPS after cardiac surgery., Methods: A total of 100 patients who were administered oral diclofenac for postoperative analgesia after cardiac surgery and until hospital discharge were included in this retrospective study. As well, 100 patients undergoing cardiac surgery who were not administered nonsteroidal anti-inflammatory drugs were included as the control group. The existence and severity of pericardial effusion were determined by echocardiography. The existence and severity of pleural effusion were determined by chest X-ray., Results: PPS incidence was significantly lower in patients who received diclofenac (20% vs. 43%) (P<0.001). Patients given diclofenac had a significantly lower incidence of pericardial effusion (15% vs. 30%) (P=0.01). Although not statistically significant, pericardial and pleural effusion was more severe in the control group than in the diclofenac group. The mean duration of diclofenac treatment was 5.11±0.47 days in patients with PPS and 5.27±0.61 days in patients who did not have PPS (P=0.07). Logistic regression analysis demonstrated that diclofenac administration (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.18-0.65, P=0.001) was independently associated with PPS occurrence., Conclusion: Postoperative administration of diclofenac may have a protective role against the development of PPS after cardiac surgery.