SESSION TYPE: Thoracic Surgery Posters I
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: To describe the incidence of pleural effusion (PE) after cardiac surgery requiring thoracocentesis and Video-Assisted Thoracoscopic Surgery (VATS) pleurodesis.
METHODS: All the patients undergoing cardiac surgery from June 2008 to November 2011 were retrospectively identified. Patients having pleural ultrasound (US), US-guided thoracocentesis or VATS pleurodesis for diagnosis or treatment of PE were recognized and their clinical records reviewed.
RESULTS: 2164 patients having cardiac surgery were identified. Pleural US for clinical or radiological suspicion of PE was performed 376 times (17%) in 242 patients (11%) to demonstrate the effusion; US-guided thoracocentesis was done in 68 patients (3.14%) for symptoms or for a large PE unlikely to resolve with medical treatment. After having at least two US-guided thoracocentesis, eight patients (0.36%) had recurrent PE and VATS pleurodesis was performed. 5/8 patients had coronary artery by-pass graft surgery while 3/8 patients had other cardiac procedures. The median elapsed time between the first thoracocentesis and VATS was 39.5 days (9-65.5 days). The mean number of US-guided drainage procedures in patients undergoing VATS pleurodesis was 3.5±1.2. Pleural fluids were exudates with high proportion of lymphocytes; the mean drained volume was 1144 ml. PE was left-sided in 5/8 patients; the indication for surgery was dyspnea in 7/8. VATS talc-pleurodesis was done in seven patients; one patient had a right VATS decortication and mechanical pleurodesis. No postoperative complications were observed. The median length of stay was 6 days (5-6 days). No PE recurrences were identified on follow-up. VATS pleural biopsies were done in 5/8. Pathology report showed chronic pleuritis with lymphocyte infiltration in all cases.
CONCLUSIONS: Although the presence of PE after cardiac surgery is a relatively common finding, the need of thoracocentesis is infrequent. Recurrent PE after cardiac surgery can be effectively treated by VATS pleurodesis with low morbidity or mortality.
CLINICAL IMPLICATIONS: Given the effectiveness and safety of VATS pleurodesis for the treatment of recurrent PE after cardiac surgery, its earlier use (after the second or even the first failed thoracocentesis) should be considered.
DISCLOSURE: The following authors have nothing to disclose: Sebastian Defranchi, Didier Bruno, Roberto Favaloro, Federico Zeppa, Alejandro Bertolotti
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