ABSTRACT
OBJECTIVE: The study aim was to investigate the long-term prognosis and risk factors of postpericardiotomy syndrome (PPS). METHODS: We performed a single-center cohort study in 822 patients undergoing nonemergent valve surgery. Risk factors of PPS were evaluated using multivariable logistic regression analysis. We also compared the incidence of reoperation for tamponade at 1 year between patients with and without PPS. Main secondary outcomes were hospital stay and mortality. RESULTS: Of the 822 patients, 119 (14.5%) developed PPS. A higher body mass index (odds ratio (OR) per point increase, 0.94; 95% confidence interval (CI), 0.89-0.99) was associated with a lower risk of PPS, whereas preoperative treatment for pulmonary disease without corticosteroids (OR, 2.55; 95% CI, 1.25-5.20) was associated with a higher risk of PPS. The incidence of reoperation for tamponade at 1 year in PPS versus no PPS was 20.9% versus 2.5% (OR, 15.49; 95% CI, 7.14-33.58). One-year mortality in PPS versus no PPS was 4.2% versus 5.5% (OR, 0.68; 95% CI, 0.22-2.08). Median hospital stay was 13 days (interquartile range, 9-18 days) versus 11 days (interquartile range, 8-15 days) (P = .001), respectively. CONCLUSIONS: Despite longer hospital stays and more short-term reoperations for tamponade, patients with PPS had an excellent 1-year prognosis.
Subject(s)
Cardiac Surgical Procedures/adverse effects , Heart Valve Diseases/surgery , Heart Valves/surgery , Postpericardiotomy Syndrome/etiology , Aged , Cardiac Surgical Procedures/mortality , Cardiac Tamponade/etiology , Cardiac Tamponade/mortality , Cardiac Tamponade/surgery , Female , Heart Valve Diseases/mortality , Humans , Length of Stay , Male , Middle Aged , Postpericardiotomy Syndrome/mortality , Postpericardiotomy Syndrome/surgery , Randomized Controlled Trials as Topic , Reoperation , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Chylopericardium is a rare complication after operation for congenital heart disease. The incidence and clinical outcomes in a large cohort of surgical patients are unknown. METHODS: We retrospectively reviewed the clinical records spanning more than 12 years in a single institution of 16 children with chylopericardium after cardiac operation. RESULTS: We identified 16 patients with chylopericardium between 1985 and 1997. Chylopericardium was isolated in 7 patients. Twelve patients required pericardial drainage. Patients with isolated chylopericardium presented late and were treated initially as having postpericardiotomy syndrome. Three patients underwent thoracic duct ligation. There were two late deaths unrelated to the chylothorax. Associated diagnoses were internal jugular vein thrombosis and recurrent pulmonary vein obstruction (1 of 16 patients), an associated syndrome but not Turner or Noonan (10 of 16), superior cavopulmonary or total cavopulmonary anastomosis (7 of 16), atrioventricular septal defect repair (5 of 16), and repair of tetralogy of Fallot (2 of 16). CONCLUSIONS: Percutaneous drainage to relieve tamponade together with a low-fat or medium-chain triglyceride diet results in resolution in most cases of postoperative chylopericardium. If a pericardial effusion enlarges, fails to clear on aspirin therapy, or presents late after hospital discharge, diagnostic pericardial tap and a low-fat diet are indicated.
Subject(s)
Heart Defects, Congenital/surgery , Pericardial Effusion/etiology , Postoperative Complications/etiology , Cause of Death , Child , Child, Preschool , Cohort Studies , Diagnosis, Differential , Female , Heart Defects, Congenital/mortality , Humans , Infant , Male , Pericardial Effusion/mortality , Postoperative Complications/mortality , Postpericardiotomy Syndrome/etiology , Postpericardiotomy Syndrome/mortality , Retrospective Studies , Risk FactorsABSTRACT
Endocardial placement of electrodes for myocardial electrostimulation is a standard procedure. In the past, myocardial electrode placement was not performed routinely mainly because of the trauma of surgical access to the heart. We have developed for the first time an endoscopic approach. It is based on the use of a rigid endoscope with a diameter of 20 mm, which is introduced via a subxyphoideal skin incision into the pericardium. A sutureless, screw-in electrode is positioned via the endoscope. 129 patients were treated successfully without method-related lethality. An advantage especially for our large country is the possibility of performing this procedure in distant hospitals without the need of X-ray facilities. The equipment can be carried in an attaché case. Further developments could include two-chamber ECS using disposable kits ready for on-the-spot use.
Subject(s)
Electrodes, Implanted , Pacemaker, Artificial , Thoracoscopes , Adult , Aged , Aged, 80 and over , Cause of Death , Female , Hospital Mortality , Humans , Male , Middle Aged , Postpericardiotomy Syndrome/etiology , Postpericardiotomy Syndrome/mortalityABSTRACT
Although coronary artery bypass surgery has become increasingly popular in recent years, recent critical reports have cast doubt on its efficacy in certain groups of patients. Our report reviews a recent experience with multiple coronary bypass grafting for triple vessel disease. From March 1976 to October 1978, 276 patients received from three to nine coronary bypass grafts. Combined procedures including valve replacement and ventricular aneurysmectomy are included. There were two operative deaths (30 days) for a 0.7% operative mortality. Eleven patients (4%) sustained a perioperative infarction. Other nonfatal operative complications are reviewed. The overall safety and low morbidity allow us to recommend coronary bypass surgery to certain controversial subsets of patients, ie, those with high-grade double and triple vessel disease with stable angina.
