PURPOSE: Our prior experience in caring for patients requiring ventricular assist device (VAD) placement taught us that pleural effusion was a common entity. Our study details the prevalence of pleural effusion in these patients and describes the characteristics of the pleural effusions.
METHODS: We conducted a retrospective review of 17 patients undergoing VAD placement from August 2004 to January 2006. Patient charts, hospital data, and radiology data were all reviewed.
RESULTS: Three of the 17 patients (18%) had pleural effusion before VAD placement. All 17 patients (100%) had pleural effusion on post op days 15 and 30. Six patients (35%) had unilateral effusions with 5/6 being left sided. Eleven patients (65%) had bilateral effusions with 8/11 being left side predominant. Two patients had large effusion (>2/3 of the hemithorax), five had moderate effusion (between 1/3 nad 2/3 of the hemithorax), and ten had small effusion (<1/3 of the hemithorax). Seven patients (41%) required thoracentesis to relieve dyspnea. All of the patients were noted to have hemorrhagic fluid and removal resulted in relief of dyspnea and improvement of clinical status. Five patients had their pleural fluid examined in detail and all met criteria for an exudate (Table). The mean LDH was 596IU/L (range 149-1154) and the mean total protein was 3.2g/dl (range 2.2-4.1). None of the effusions grew any organism from cultures. No complications from thoracentesis were experienced. Eleven patients (65%) had either partial or complete resolution of pleural effusion by post op day 60 and none required repeat thoracentesis.
CONCLUSION: Pleural effusion is a common complication of VAD placement. In our study, the effusions were left side predominant, exudative in nature, and hemorrhagic. Drainage resulted in improvement in symptoms and seemed to facilitate resolution in 7/11 patients. Further studies are needed to elucidate the cause of the pleural disease in these patients.
CLINICAL IMPLICATIONS: Physicians caring for patients after VAD placement should anticipate the development of pleural effusion. Drainage of the effusion may be beneficial if dyspnea becomes problematic.
DISCLOSURE: William Lunn, None.