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Eastern Cardiothoracic Surgical Society

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Better Pericardial Drainage After Cardiac Surgery Leads to Better Outcomes

Objective: Studies of chest tubes(CTs) for pericardial evacuation after cardiac surgery have shown ineffective drainage exacerbates post-operative complications related to retained fluid. We evaluated our hypothesis—maintaining patency decreases complications—by evaluating post-operative outcomes for cardiac patients who received active clearance technology(ACT) CTs.
METHODS: Between February 2018 and March 2019, 600 patients underwent cardiac surgery at a single institution and received ACT CTs. Outcomes data were collected prospectively. These 600 patients were retrospectively compared to 2,000 historical controls. Propensity score matching was conducted on 22 covariates using a 0.1 caliper logistic model with nearest neighbor 1:1 matching. Matched pairs outcomes were evaluated using Wilcoxon signed rank or McNemar’s test. Post-operative complications, 30-day mortality, and retained blood complications (hemothorax, reoperation for hemorrhage, pericardial drainage, CT placement/replacement, thoracentesis, or thoracotomy) were evaluated (Table).
Results: Propensity scoring yielded 477 patients in the ACT group matched to 477 controls. There was a 91% reduction in the retained blood/intervention endpoint for ACT patients vs controls [2(<1%) vs 23(5%); P<0.001]. ACT patients had decreased infection rates [0(0%) vs 7(1%); P=0.023], postoperative blood products [255(53%) vs 291(61%); P=0.026], reoperation for hemorrhage [0(0%) vs 11(2%); P=0.003], and reintubation [0(0%) vs 7(1%); P=0.023]. There was no difference in in-hospital POAF, post-surgery length of stay, or 30-day mortality.
Conclusions: Implementing ACT was associated with decreased complications related to retained blood, postoperative blood products, and reoperations related to retained blood problems. Thus, ACT warrants consideration in cardiac patients. A randomized trial is needed to verify these findings.


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