scholarly journals Ten-Year Clinical Experience on Chylothorax after Cardiovascular Surgery

2020 ◽  
Vol 23 (1) ◽  
pp. E081-E087 ◽  
Author(s):  
Doğan Kahraman ◽  
Gökhan Keskin ◽  
Emced Khalil ◽  
Omer Faruk Dogan
Keyword(s):  
Cardiac Surgery ◽  
Pleural Effusion ◽  
Medical Treatment ◽  
Fibrin Glue ◽  
Clinical Experience ◽  
Cardiovascular Surgery ◽  
Chemical Pleurodesis ◽  
Ductus Thoracicus ◽  
Duct Ligation ◽  
The Mean

Background: Chylothorax or pseudo-chylothorax is a serious complication after adult and pediatric cardiac surgery. This study presents our 10-year clinical experience of chylothorax after cardiac surgery. Methods: Between January 2008 and February 2019, 4896 cardiovascular surgeries were performed in 2 tertiary clinics, with 416 patients in the pediatric age group (8.4%). Chylothorax and pseudo-chylothorax were detected in 47 patients (22 adult and 20 pediatric patients, 4.8%). Pseudo-chylothorax was seen in 5 adult patients. In 27 patients, a pleural effusion developed on the left side (64.2%). Quantities of chylomicron in pleural effusion were significant in all patients. In addition, protein and lactate dehydrogenase levels were >2.9 g/dL. The cholesterol level in the pleural effusion was >2.49 mmol/L in all patients. The mean latency period was 8 days (range 3.1 to 63.1). For the management of chylothorax, somatostatin or octreotide as a somatostatin analog was administered in 23 patients (15 adult and 8 pediatric) in the intensive care unit. Somatostatin or octreotide was administered intravenously or subcutaneously at a dose of 0.3 to 4 µg/(kg · h–1). We used dexamethasone as a steroid combined with somatostatin in patients who were resistant to medical treatment before pleurodesis or ductus closure. Classic chemical pleurodesis combined with fibrin glue was performed in 11 patients (8 adult and 3 pediatric). Surgical duct ligation, as the last option, was performed in 7 patients. Results: No mortality or morbidity was observed. Chylothorax improved with the medical approach in 23 patients within 24.2 ± 11.3 days (48.9%). We successfully performed the pleurodesis procedure using fibrin glue in addition to the classic method. The mean duration of conservative treatment was 27.1 days (range 11 to 39). After discharge from the hospital, 2 children had recurrence of chylothorax, and the ductus thoracicus was surgically ligated. No complication was seen during or after ductus ligation. Conclusions: According to our clinical experience, chylothorax is not an extremely rare complication after cardiac surgery in pediatric cardiovascular surgery. A number of patients with chylothorax may be treated medically and with diet adjustment. Medical treatment including steroid administration may be the first treatment strategy immediately after diagnosis. Classic chemical pleurodesis combined with fibrin glue may be applied in the early stages. Surgical ligation of the ductus thoracicus should be considered the last treatment option.

Further clinical experience with autologous fibrin glue in cardiovascular surgery

1995 ◽  
Vol 3 ◽  
pp. 7-8
Author(s):  
R TAWES ◽  
T DUVALL
Keyword(s):  
Fibrin Glue ◽  
Clinical Experience ◽  
Cardiovascular Surgery ◽  
Autologous Fibrin Glue

scholarly journals Cardiac surgery for patients with schizophrenia: clinical experience of six patients

Surgery Today ◽  
2021 ◽  
Author(s):  
Mutsuo Tanaka ◽  
Minoru Okamoto ◽  
Kensho Yamashita
Keyword(s):  
Cardiac Surgery ◽  
Causes Of Death ◽  
Perioperative Management ◽  
Cardiovascular Surgery ◽  
Artery Bypass ◽  
Cardiovascular Complications ◽  
Bypass Grafting ◽  
Careful Monitoring ◽  
The Mean ◽  
Observation Period

Abstract Purpose The incidence of schizophrenia in Japan is 0.7%, which is similar to the worldwide incidence. The mortality rate of patients with schizophrenia is reported to be higher than that of the general population, and cardiovascular disease is high among the causes of death. Hence, strategies for cardiovascular surgery for patients with schizophrenia are necessary. Methods We studied six patients with schizophrenia (five males, one female) who underwent cardiac surgery in our hospital between April 2008 and December 2019. Result The mean age was 63.6 years. The surgical procedures were coronary artery bypass grafting (CABG) (n = 4), CABG concomitant with valve procedures (n = 1), and resection of myxoma (n = 1). There were no major cardiovascular complications and no other fatal complications. The mean observation period was 1510.6 ± 1430.1 (140–4068) days, the mean post-operative hospital stay was 17.8 ± 3.5 (13–22) days, and there was no mortality within 30 days after surgery. During the observation period, one patient died. The survival rate was 83.3% at 1, 3, and 5 years. Conclusion Cardiac surgery for patients with schizophrenia is possible with careful monitoring of indications and perioperative management.

scholarly journals Combination Therapy with Etilefrine and Pleurodesis for Refractory Congenital Chylothorax

2020 ◽  
Vol 5 (3) ◽  
pp. 1-5
Author(s):  
Yutaro Tomobe ◽  
Uiko Mizuguchi ◽  
Akihiro Shimotakahara ◽  
Naoki Shimojima ◽  
Kaoru Okazaki
Keyword(s):  
Pleural Effusion ◽  
Combination Therapy ◽  
Thoracic Duct ◽  
Preterm Neonate ◽  
Chemical Pleurodesis ◽  
Thoracic Duct Ligation ◽  
Duct Ligation ◽  
Chylous Pleural Effusion ◽  
Congenital Chylothorax ◽  
Viable Treatment

Etilefrine, a sympathomimetic agent, is reportedly effective against postoperative chylothorax. However, its effectiveness in treating congenital chylothorax was unknown. We report herein a case of refractory congenital chylothorax treated with etilefrine in a late preterm neonate with massive fetal chylous pleural effusion. The chylothorax was unresponsive to previous treatments, including dietary and pharmacological treatment and thoracic duct ligation. The pleural effusion decreased after intravenous etilefrine was begun on day of life (DOL) 84 and resolved after the addition of chemical pleurodesis with OK-432 on DOL 90. This combination therapy may be a viable treatment option for cases of congenital chylothorax that are unresponsive to other treatments.

Abstract 11867: Late Stroke Rates After Maze Procedure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hiroshi Tsuneyoshi ◽  
Tatsuhiko Komiya ◽  
Takeshi Shimamoto
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Cardiovascular Surgery ◽  
Maze Procedure ◽  
Hemorrhagic Events ◽  
The Mean

Introduction: Late stroke can affect quality of life after cardiac surgery. Atrial fibrillation is the most common cardiac arrhythmia and raises the risk of stroke; however, the incidence of late stroke after the Maze procedure has not been determined. Methods: We conducted a retrospective review of 4021 patients who underwent cardiac surgery at our institution between 2000 and 2013. Results: Follow-up data were obtained from 88% of patients at a mean of 4.8±3.4 years. Among these patients, 2.4% (95/4021) experienced symptomatic late stroke (mean period after surgery was 55±35 months, and the mean age was 72±13 years). About 32% (30/95) of patient strokes were caused from atrial fibrillation, 2% (2/95) from hemorrhagic events, 3% (3/95) from cerebral artery diseases, and 63% (60/95) from unknown causes. Among 345 of the 4021 patients who underwent the Maze procedure (Full Maze: 157, LA Maze: 132, PV isolation: 56), 70.5% have remained in sinus rhythm as of their last follow-up. Just 4.3% (15/345) of patients that underwent the Maze procedure had a late stroke during the follow-up period. Of the 15 patients who had a late stroke, 10 failed the Maze procedure and remained in atrial fibrillation. In 60% (9/15) of patients experiencing a late stroke after the Maze procedure, the LA appendage was not closed at the time of surgery. Conclusions: The cause of late stroke after cardiovascular surgery was atrial fibrillation in not less than 30% of patients. The incidence of late stroke after the Maze procedure was 4.3%, which was relatively low considering these patients had arrhythmia problems before the operation (2.4% of all cardiac patients experienced a late stroke). Unsuccessful cases of the Maze procedure and non-LA appendage closure were considered risk factors for late stroke. When patients have atrial fibrillation prior to surgery, we recommend a concomitant Maze procedure or at least LA appendage closure to reduce the incidence of late stroke.

The effect of iodopovidone versus bleomycin in chemical pleurodesis

2018 ◽  
Vol 26 (5) ◽  
pp. 382-386 ◽  
Author(s):  
Reza Bagheri ◽  
Marzieh Noori ◽  
Maryam Rajayi ◽  
Davood Attaran ◽  
Amir Mohammad Hashem Asna Ashari ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Povidone Iodine ◽  
Response To Therapy ◽  
Chest Drain ◽  
Chemical Agent ◽  
Efficacy And Safety ◽  
Chemical Pleurodesis ◽  
Relapse Time ◽  
The Mean

Background Malignant pleural effusion continues to be a common problem in patients with metastatic disease. This study was conducted to compare the efficacy and safety of bleomycin pleurodesis with povidone-iodine pleurodesis through a chest drain as palliative treatment for recurrent malignant pleural effusion. Methods Sixty cancer patients (36 males and 24 females) with recurrent malignant pleural effusion were enrolled in a prospective randomized trial. Thirty patients received povidone-iodine pleurodesis and 30 received bleomycin pleurodesis. Age, sex, side of the primary pathology, treatment outcome (recurrence and relapse time), and complications were analyzed. Results The mean age was 59.63 ± 7.68 years in the povidone-iodine group and 57.97 ± 9.27 years in the bleomycin group ( p = 0.452). The complications were identical in both groups: 2 (6.7%) patients had chest pain, 2 (6.7%) had fever, and one (3.3%) had hypotension. There was a good response to therapy in 20 (66.7%) patients in the bleomycin group and 25 (83.3%) in the povidone-iodine group ( p = 0.136). Conclusion The results of this study indicate that povidone-iodine should be considered as a selective chemical agent to perform pleurodesis in patients with recurrent malignant pleural effusion because it has the same effect but costs less than bleomycin.

Clinical Experience with Fibrin Glue in Cardiac Surgery

1981 ◽  
Vol 29 (05) ◽  
pp. 287-289 ◽  
Author(s):  
G. Köveker ◽  
E. de Vivie ◽  
K. Hellberg
Keyword(s):  
Cardiac Surgery ◽  
Fibrin Glue ◽  
Clinical Experience

The Effect of Desmopressin on Reducing Blood Loss in Cardiac Surgery – A Meta-Analysis of Double-Blind, Placebo-Controlled Trials

1995 ◽  
Vol 74 (04) ◽  
pp. 1064-1070 ◽  
Author(s):  
Marco Cattaneo ◽  
Alan S Harris ◽  
Ulf Strömberg ◽  
Pier Mannuccio Mannucci
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Meta Analysis ◽  
Postoperative Blood Loss ◽  
Controlled Trials ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Transfusion Requirements ◽  
The Mean ◽  
Excessive Blood Loss

SummaryThe effect of desmopressin (DDAVP) on reducing postoperative blood loss after cardiac surgery has been studied in several randomized clinical trials, with conflicting outcomes. Since most trials had insufficient statistical power to detect true differences in blood loss, we performed a meta-analysis of data from relevant studies. Seventeen randomized, double-blind, placebo-controlled trials were analyzed, which included 1171 patients undergoing cardiac surgery for various indications; 579 of them were treated with desmopressin and 592 with placebo. Efficacy parameters were blood loss volumes and transfusion requirements. Desmopressin significantly reduced postoperative blood loss by 9%, but had no statistically significant effect on transfusion requirements. A subanalysis revealed that desmopressin had no protective effects in trials in which the mean blood loss in placebo-treated patients fell in the lower and middle thirds of distribution of blood losses (687-1108 ml/24 h). In contrast, in trials in which the mean blood loss in placebo-treated patients fell in the upper third of distribution (>1109 ml/24 h), desmopressin significantly decreased postoperative blood loss by 34%. Insufficient data were available to perform a sub-analysis on transfusion requirements. Therefore, desmopressin significantly reduces blood loss only in cardiac operations which induce excessive blood loss. Further studies are called to validate the results of this meta-analysis and to identify predictors of excessive blood loss after cardiac surgery.

Comparison of Heffner Criteria and Light Criteria in Differentiating Exudative and Transudative Pleural Effusion

2020 ◽  
Vol 22 (3) ◽  
pp. 141-145
Author(s):  
Krishna Chandra Devkota ◽  
S Hamal ◽  
PP Panta
Keyword(s):  
Pleural Effusion ◽  
Cross Sectional Study ◽  
Pleural Space ◽  
Sectional Study ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Medical College ◽  
The Common ◽  
The Mean ◽  
Exudative Pleural Effusion

Pleural effusion is present when there is >15ml of fluid is accumulated in the pleural space. It can be divided into two types; exudative and transudative pleural effusion. Tuberculosis and parapneumonic effusion are the common cause of exudative pleural effusion whereas heart failure accounts for most of the cases of transudative pleural effusion. This study was a hospital based cross sectional study performed at Nepal Medical College during the period of January 2016-December 2016. A total of 50 patients who fulfilled the inclusion criteria were enrolled. Pleural effusion was confirmed by clinical examination and radiology. After confirmation of pleural effusion, pleural fluid was aspirated and was analysed for protein, LDH, cholesterol. The Heffner criteria was compared with Light criteria to classify exudative or transudative pleural effusion. Among 50 patients, 30 were male and 20 were female. The mean age of patient was 45.4±21.85 years. The sensitivity and specificity of using Light criteria to detect the two type of pleural effusion was 100% and 90.9%, whereas using Heffner criteria was 94.87%, 100% respectively(P<0.01). There are variety of causes for development of pleural effusion and no one criteria is definite to differentiate between exudative or transudative effusion. In this study Light criteria was more sensitive whereas Heffner criteria was more specific to classify exudative pleural effusion. Hence a combination of criteria might be useful in case where there is difficulty to identify the cause of pleural effusion.

Validation of the CASUS score in Tunisian patients: a quality management tool in intensive care units

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
T Besbes ◽  
S Mleyhi ◽  
J Sahli ◽  
M Messai ◽  
J Ziadi ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Roc Curve ◽  
Goodness Of Fit ◽  
Cardiovascular Surgery ◽  
Management Tool ◽  
Medical Decision ◽  
Tunisian Population ◽  
Correct Classification ◽  
Goodness Of Fit Test ◽  
A Value

Abstract Background Early prediction of patients at highest risk of a poor outcome after cardiovascular surgery, including death can aid medical decision making, and adapt health care management in order to improve prognosis. In this context, we conducted this study to validate the CASUS severity score after cardiac surgery in the Tunisian population. Methods This is a retrospective cohort study conducted among patients who underwent cardiac surgery under extracorporeal circulation during the year 2018 at the Cardiovascular Surgery Department of La Rabta University Hospital in Tunisia. Data were collected from the patients hospitalization records. The discrimination of the score was assessed using the ROC curve and the calibration using the Hosmer-Lemeshow goodness of fit test and then by constructing the calibration curve. Overall correct classification was also obtained. Results In our study, the observed mortality rate was 10.52% among the 95 included patients. The discriminating power of the CASUS score was estimated by the area under the ROC curve (AUC), this scoring system had a good discrimination with AUC greater than 0.9 from postoperative Day 0 to Day 5.From postoperative day 0 to day 5, the Hosmer-Lemeshow's test gave a value of chi square test statistic ranging from 1.474 to 8.42 and a value of level of significance ranging from 0.39 to 0.99 indicating a good calibration. The overall correct classification rate from postoperative day 0 to day 5 ranged from 84.4% to 92.4%. Conclusions Despite the differences in the profile of the risk factors between the Tunisian population and the population constituting the database used to develop the CASUS score, we can say that this risk model presents acceptable performances in our population, attested by adequate discrimination and calibration. Prospective and especially multicentre studies on larger samples are needed before definitively conclude on the performance of this model in our country. Key messages The casus score seems to be valid to predict mortality among patients undergoing cardiac surgery. Multicenter study on larger sample is needed to derive and validate models able to predict in-hospitals mortality.

scholarly journals SAT0267 ROLE OF AGGRESSIVE IMMUNOSUPPRESSION ON SUBGLOTTIC STENOSIS IN GRANULOMATOSIS WITH POLYANGIITIS: RETROSPECTIVE ANALYSIS OF A MONOCENTRIC COHORT

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1076.1-1077
Author(s):  
L. Moroni ◽  
L. Giudice ◽  
G. A. Ramirez ◽  
S. Sartorelli ◽  
A. Cariddi ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Clinical Characteristics ◽  
Granulomatosis With Polyangiitis ◽  
Balloon Catheter ◽  
Subglottic Stenosis ◽  
Damage Accrual ◽  
The Mean ◽  
The One

Background:Subglottic stenosis (SGS) is defined as airway narrowing below the vocal cords and is a common and potentially life-threatening manifestation of Granulomatosis with Polyangiitis (GPA), with an estimated prevalence of 16-23% (1). Balloon catheter dilation is effective in GPA-related SGS, but relapses are frequent. Little is known about the role of immunosuppression in this setting.Objectives:to analyse the clinical characteristics of a monocentric GPA cohort, describe phenotype differences among patients with and without SGS and investigate the role of surgical and medical treatments on relapse risk and general outcome.Methods:Biopsy-proven patients with SGS were identified by review of medical charts among a cohort of patients with GPA, classified according to the algorithm of the European Medicine Agency (2). The clinical characteristics of patients with SGS were retrospectively collected over a median follow-up time of 15.9 years and compared to those of patients without SGS.Results:Fourteen patients with SGS-GPA were identified, with a female to male ratio of 1:1 and a prevalence of 29.2% among the cohort. The mean ± SD age at GPA onset was 30.8 ± 14.4 years, with a mean time from GPA diagnosis to SGS onset of 4.7 ± 4.2 years. ANCA were positive in 78.6% (54.0% anti-PR3, 18.1% anti-MPO and 27.9% IFI only). The mean Birmingham Vasculitis Activity Score (BVAS) at onset was 10.0 ± 5.6. The main clinical manifestations associated with SGS were crusty rhinitis (100%), sinusitis (78%), pulmonary disease (72.7%), otitis/mastoiditis (50%), glomerulonephritis (42.9%), orbital pseudotumor (28.6%). Six patients (42.9%) received medical treatment only, other six (42.9%) had one to three balloon dilations and two (14.2%) underwent four or more procedures. Eight patients had no SGS relapse (maximum one dilation) and they all received immunosuppression with rituximab (RTX), cyclophosphamide (CYC) or azathioprine (AZA). All patients who received no immunosuppression, methotrexate (MTX) or mycophenolate (MMF) had at least one relapse. Patients treated with MTX or MMF had a mean relapse-free survival of 13.1 months, which was comparable to the one of patients not receiving medical treatment (40.2 months; p=NS) and shorter than the one of patients receiving CYC or RTX (153.2 months; p=0.032). CYC use also inversely correlated with the number of surgical procedures (r=-0.691, p=0.006). Compared to patients without SGS (31 consecutive patients with at least 4 years of follow-up), patients with SGS-GPA had an earlier disease onset (mean age 30.8 vs 50.4 years; p<0.001), but with lower BVAS (mean 10.0 vs 15.3; p=0.013) and showed a higher prevalence of crusty rhinitis (100% vs 67.7%; p=0.019). No difference was observed in damage accrual over time between the two groups.Conclusion:Subglottic stenosis is highly prevalent in patients with GPA and may define a milder disease subset occurring more frequently in younger patients. MTX and MMF might be insufficient to prevent SGS relapses requiring balloon dilation. Aggressive immunosuppression (CYC or RTX) might have a non-redundant role in this setting and reduce the risk of relapses.References:[1]Quinn KA, et al. Subglottic stenosis and endobronchial disease in granulomatosis with polyangiitis. Rheumatology 2019; 58 (12), 2203-2211.[2]Watts R, et al. Development and validation of a consensus methodology for the classification of the ANCA associated vasculitides and polyarteritis nodosa for epidemiological studies. Ann Rheum Dis 2007; 66: 222-7.Disclosure of Interests:Luca Moroni: None declared, Laura Giudice: None declared, Giuseppe Alvise Ramirez: None declared, Silvia Sartorelli: None declared, adriana cariddi: None declared, Angelo Carretta: None declared, Enrica Bozzolo: None declared, Lorenzo Dagna Grant/research support from: The Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR) received unresctricted research/educational grants from Abbvie, Bristol-Myers Squibb, Celgene, Janssen, Merk Sharp & Dohme, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI., Consultant of: Prof Lorenzo Dagna received consultation honoraria from Abbvie, Amgen, Biogen, Bristol-Myers Squibb, Celltrion, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI.

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