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A 16‐year‐old male with past medical history of congenital atrial septal defect surgical repair, presented with recurrent pericarditis secondary to post‐cardiotomy injury syndrome (PCIS), After failing medical therapy, he ultimately underwent pericardiectomy for symptom resolution, PCIS is underdiagnosed in children and should be considered in patients with recurrent chest, pain. [ABSTRACT FROM AUTHOR]

Post‐pericardiotomy syndrome (PPS) is a common inflammatory process following cardiac surgery, in which the pericardial space was opened. Pericardial effusion (PE) is a common manifestation in PPS; however, coronary artery dilation is not associated with PPS. Inflammatory vasculitis in children are known to cause coronary dilation, in conditions such as in Kawasaki Disease (KD). We report a patient with PPS and concomitant coronary dilation by transthoracic echocardiography (TTE) following repair of her ventricular septal defect (VSD). [ABSTRACT FROM AUTHOR]

Background. Cardiac surgery carries a well-known risk of perioperative myocardial infarction (MI), which is associated with high morbidity and both in-hospital and late mortality. The rapid haemodynamics deterioration and presence of myocardial ischemia early after cardiac surgical operations is a complex life-threatening condition where rapid diagnosis and management is of fundamental importance. Objective. To analyse the factors associated with mortality of patients with postcardiotomy MI and to study the role of emergency coronary angiography in management and outcome. Methods. We retrospectively enrolled adult patients diagnosed to have postcardiotomy MI and underwent emergency coronary angiography at our tertiary care hospital between January 2016 and August 2019. Results. Sixty-one patients from consecutive 1869 adult patients who underwent cardiac surgeries were enrolled in our study. The studied patients had a mean age of 49 ± 16.2 years with a mean BMI of 29.5 ± 6.6 and 65.6% of them were males. As compared to the survivors group, the nonsurvivors of perioperative MI had significant preoperative CKD, postoperative AKI, longer CPB time, frequent histories of previous PCI, previous cardiotomies, pre and postoperative ECMO use, higher median troponin I levels, higher peak and 24 hours median lactate levels. Regression analysis revealed that reoperation for revascularization (OR: 23; 95% CI: 8.27–217.06; P = 0.034) and hyperlactataemia (OR: 3.21; 95% CI: 1.14–9.04; P = 0.027) were independent factors associated with hospital mortality after perioperative MI. Hospital mortality occurred in 25.7% vs 86.7% (P < 0.001), AKI occurred in 37.1% vs 93.3% (P < 0.001), haemodialysis was used in 28.6% vs 80% (P = 0.002), and mediastinal exploration for bleeding was performed in 31.4% vs 80% (P = 0.006) in the PCI and reoperation groups, respectively, while there were no significant differences regarding gastrointestinal bleeding, cerebral strokes, or intracerebral bleeding. The median peak troponin level was 795 (IQR 630–1200) vs 4190 (IQR 3700–6300) (P < 0.001) in the PCI and reoperation groups, respectively. Absence of significant angiographic findings occurred in 18% of patients. Conclusions. Perioperative MI is associated with significant morbidities and hospital mortality. Reoperation for revascularization and progressive hyperlactataemia are independent predictors of hospital mortality. Emergency coronary angiography is helpful in diagnosis and management of perioperative MI. [ABSTRACT FROM AUTHOR]

Background Postpericardiotomy syndrome ( PPS) is a common complication following cardiac surgery; however, the exact pathogenesis remains uncertain. Identifying risk factors of PPS might help to better understand the syndrome. The aim of this study was to provide an overview of existing literature around determinants of PPS in adult cardiac surgery patients. Material and methods Two independent investigators performed a systematic search in MEDLINE, EMBASE and the Cochrane Central Register. The search aimed to identify studies published between January 1950 and December 2015, in which determinants of PPS were reported. Results A total of 19 studies met the selection criteria. In these studies, 14 different definitions of PPS were used. The median incidence of PPS was 16%. After quality assessment, seven studies were considered eligible for this review. Lower preoperative interleukin-8 levels and higher postoperative complement conversion products were associated with a higher risk of PPS. Among other clinical factors, a lower age, transfusion of red blood cells and lower preoperative platelet and haemoglobin levels were associated with a higher risk of PPS. Colchicine use decreased the risk of PPS. Conclusion We found that both the inflammatory response and perioperative bleeding and coagulation may play a role in the development of PPS, suggesting a multifactorial aetiology of the syndrome. Due to a lack of a uniform definition of PPS in the past, study comparability was poor across the studies. [ABSTRACT FROM AUTHOR]

Aims Colchicine has been suggested to be beneficial in preventing recurrent pericarditis. The goal of this study was to review all randomized controlled trials that assess the use of colchicine for the prevention and treatment of cardiac diseases. Methods We performed a meta-analysis of the effects of colchicine on pericarditis, postpericardiotomy syndrome and postprocedural atrial fibrillation recurrence, in-stent restenosis, gastrointestinal adverse effects, and treatment discontinuation rates. We conducted an EMBASE and MEDLINE search for prospective controlled trials. Results We identified 17 prospective controlled randomized studies with 2082 patients that received colchicine and 1982 controls with an average follow-up duration of 12 months. Treatment with colchicine is associated with reduced risk of pericarditis recurrence/postpericardiotomy syndrome ( OR: 0.37; 95% CI: 0.29-0.47; P<0.001) and lower recurrence of atrial fibrillation rates after cardiac surgery and ablation procedures. However, gastrointestinal side effects were more common in patients treated with colchicine ( OR: 2.6; 95% CI: 1.82-3.72; P<0.001) in all subgroups except for those treated for prevention of recurrent pericarditis. The higher rates of side effects resulted in higher incidence of treatment discontinuation in patients treated with colchicine. Conclusion Colchicine appears to be efficacious and well tolerated for recurrent pericarditis/postpericardiotomy syndrome and recurrence of postprocedural atrial fibrillation. However, its efficacy may be limited by its gastrointestinal adverse events and treatment discontinuation rates particularly in postoperative patients. [ABSTRACT FROM AUTHOR]

Poor survival has been demonstrated after ventricular assist device ( VAD) implantation for Interagency Registry for Mechanically Assisted Circulatory Support ( INTERMACS) profile 1 and 2 patients compared with more stable levels. However, risk factors within this high-risk cohort have not been determined so far. The aim of the present study was to identify risk factors associated with this very high mortality rate. Between February 1993 and January 2013, 298 patients underwent VAD implantation in our institution. One hundred nine patients were in INTERMACS level 1 and 49 patients were in INTERMACS level 2 and were therefore defined as hemodynamically critical (overall 158 patients). Assist devices implanted were: HVAD HeartWare n = 18; Incor n = 11; VentrAssist n = 2; DeBakey n = 22; and pulsatile systems n = 105. After cumulative support duration of 815.35 months, Kaplan- Meier analysis revealed a survival of 63.9, 48.8, and 40.3% at 1, 6, and 12 months, respectively. Cox regression analyses identified age > 50 ( P = 0.001, odds ratio [OR] 2.48), white blood cell count > 13.000/μL ( P = 0.01, OR 2.06), preoperative renal replacement therapy ( P = 0.001, OR 2.63), and postcardiotomy failure ( P < 0.001, OR 2.79) as independent predictors of mortality. Of note, last generation VADs were not associated with significantly better 6-month survival ( P = 0.59). Patients without the aforementioned risk factors could yield a survival of 79.2% at 6 months. This single-center experience shows that VAD implantation in hemodynamically unstable patients generally results in poor early outcome, even in third-generation pumps. However, avoiding the aforementioned risk factors could result in improved outcome. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to evaluate nationwide outcomes of ventricular assist device (VAD) implantation in elderly patients in the United States. Methods Patients undergoing VAD implantation between 2003 and 2008 were identified in the Nationwide Inpatient Sample. The primary outcome was inpatient mortality following VAD implantation. Secondary outcomes included disposition following discharge and costs of care. After stratification based on primary versus postcardiotomy VAD support, outcomes were compared between controls aged 60-69 years and elderly patients aged ≥70 years. Results A total of 2787 patients aged 60-69 years and 1472 patients aged ≥70 years underwent VAD implantation during the study period. Unadjusted mortality rates were comparable between elderly and control patients in both primary support (35.7% vs. 32.1%, p = 0.61) and postcardiotomy support (58.1% vs. 56.1%, p = 0.70). Similarly, in risk-adjusted multivariable logistic regression analysis incorporating clinically relevant variables, age ≥70 did not exert an independent effect on inpatient mortality for either indication. Inpatient costs in the elderly were lower than controls in the primary support cohort, although costs per day were similar, with comparable overall costs between age groups in the postcardiotomy cohort. Elderly survivors were discharged to a facility more frequently than control survivors (primary: 49.9% vs. 29.6%, p = 0.007; postcardiotomy: 67.4% vs. 45.7%, p = 0.03). Conclusions This large-cohort population-based analysis provides a useful framework for inpatient prognosis and resource utilization in elderly patients undergoing VAD implantation. Although mortality rates and costs were found to be comparable between elderly patients and those aged 60-69 years, these rates were nonetheless significant. This combined with more frequent discharge-to-facility in elderly survivors underscores the importance of careful patient selection in this population. doi: 10.1111/jocs.12066 (J Card Surg 2013;28:183-189) [ABSTRACT FROM AUTHOR]

Background: Postcardiotomy cardiogenic shock (PCS) is often fatal despite inotropic and circulatory support. We compared our experience with the CentriMag left ventricular assist device (LVAD) for patients with PCS at two time periods: in the operating room (OR) after unsuccessful weaning from cardiopulmonary bypass (CPB) and after transfer to the intensive care unit (ICU). Methods: We reviewed 22 patients' records (13 men, nine women; age, 65 ± 12 years) who underwent open heart surgery (January 2004 to September 2009) and required LVAD support for PCS despite maximal inotropic and intra-aortic balloon pump (IABP) support. In ten patients who could not be weaned from CPB despite high-dose inotropic therapy (≥ 3 agents) and IABP support, the CentriMag was implanted in the OR (immediate group). The other 12 patients were weaned from CPB with high-dose inotropic therapy and IABP but became increasingly unstable or had a cardiac arrest in the ICU, and the CentriMag was implanted for circulatory support (delayed group). Results: Preoperatively, the average ejection fraction was 40%± 12%, the creatinine level was 1.6 ± 0.6 mg/dL, and the European Systematic Coronary Risk Evaluation was 13.1 ± 4.6. The duration of CentriMag support was 5 ± 3 days. The immediate group had significantly better survival (7/10 vs. 2/12, p = 0.027), higher cardiac index (2.4 ± 0.3 L/min/m2 vs. 1.7 ± 0.3 L/min/m2, p = 0.001), and lower pulmonary capillary wedge pressure (20 ± 6 mmHg vs. 29 ± 8 mmHg, p = 0.024) than the ICU group. No perioperative complications related to device implantation occurred. Conclusion: In patients with PCS, timely placement of a CentriMag LVAD may increase the chance of eventual recovery. (J Card Surg 2011;26:548-552) [ABSTRACT FROM AUTHOR]

Background: An increasing number of patients requiring ventricular assist devices (VAD) have had previous valvular corrections, including valve repair and valve replacement with mechanical or bioprosthetic valves. The operative and peri-operative management of these patients has been varied. Methods: A retrospective study of VADs between January 1994 and June 2008 revealed 10 patients with previous prosthetic valves requiring management during and after VAD placement. Three patients were supported postcardiotomy after valve surgery. Two patients were supported due to cardiogenic shock postoperatively. Four patients were supported as a bridge to transplantation. One patient was supported as a destination therapy (DT). Results: The mitral, valve was left untreated during VAD implantation regardless of valve repair or replacement. For aortic valves, the mechanical aortic valve was replaced with tissue valve in two patients and left untreated in one case. One patient had tricuspid valve repair previously and was left untouched. All patients with prosthetic valves in aortic, mitral and tricuspid position during VAD support received anticoagulation therapy. There were four deaths, and four went on to transplantation. One patient was weaned from VAD and discharged from the hospital. One patient received HeartMate I as DT. The most common causes of death were multisystem organ failure (MSOF) and sepsis. One patient had a thromboembolic event. Conclusions: The survival rate of 60% is encouraging when compared to overall survival rates. The most common cause of death was MSOF. Patients with prosthetic valves may be safely managed during VAD support. (J Card Surg 2010;25:601-605) [ABSTRACT FROM AUTHOR]

Postcardiotomy cardiogenic shock (PCCS) complicates 0.2% to 6% of cardiac operations and is a clinical entity fraught with considerable morbidity and mortality. A previous review of this topic by our group suggested that regardless of device, only 25% of patients survived to hospital discharge. In the interim, newer technologies have entered the clinical arena. Additional contributions have been made to the literature and new databases are collecting data that are likely to provide more robust guidance for the management of these very complex patients. In this review, we update the experience of mechanical support in the PCCS patient and provide a strategy to maximize survival for a patient who develops PCCS in the community cardiac surgery center. (J Card Surg 2010;25:442-454) [ABSTRACT FROM AUTHOR]

Postcardiotomy right ventricular (RV) failure develops during the perioperative period following pulmonary hypertensive crisis or acute myocardial infarction. This study reports our institutional experience in treating these patients with extracorporeal life support (ECLS). Between June 2002 and July 2005, 46 adults were treated with ECLS for postcardiotomy shock. Acute RV failure was the cause of support in 14 (30%). Patient mean age was 55.7 ± 15.4 years. Cardiac pathologies were valvular ( n = 7), coronary ( n = 1), combined coronary and valvular disease ( n = 2), complex congenital heart ( n = 2), aortic aneurysm ( n = 1), and cardiomyopathy post heart transplant ( n = 1). The triggers of RV failure were pulmonary hypertension ( n = 6), RV infarction ( n = 4), and not defined ( n = 4). Patients were supported on ECLS for a mean duration of 71 ± 52 h (range, 10–183 h). Major complications included acute renal failure requiring hemodialysis ( n = 4), reexploration for bleeding ( n = 2), and acute subdural hematoma ( n = 1). Nine (64%) patients were successfully weaned from ECLS, and seven (50%) survived to discharge. Preexisting pulmonary hypertension had a favorable tendency for weaning, and acute renal failure requiring hemodialysis correlated with in-hospital mortality. ECLS is beneficial for treating postcardiotomy RV failure when conventional therapy is exhausted. As it can be deployed rapidly and does not require resternotomy for weaning, ECLS could be regarded as the first choice of mechanical support for postcardiotomy RV failure. [ABSTRACT FROM AUTHOR]

Despite the recent advances in myocardial protection, surgical techniques, intra-aortic balloon therapy, and maximal pharmacological support, postoperative ventricular dysfunction continues to occur in 0.5–1.0% of all patients undergoing cardiac surgery. Ventricular assist device (VAD) is an important therapeutic adjunct in treating patients with profound ventricular dysfunction with postcardiotomy cardiogenic shock. The purpose of this report was to describe the clinical results with the China-made Luo-Ye VAD as a short-term circulatory support. From May 1998 to December 2006, 17 patients with postcardiotomy cardiogenic shock were supported by the Luo-Ye VAD. Of these patients, 10 were males and seven were females with a mean age of 49.6 years (range 36–68 years). All cases were supported by left VAD (LVAD). Mean duration of support was 46.3 h (range 13–113 h). A criteria of insertion was established to standardize implantation criteria. Among the 17 patients treated with LVAD, eight (47.1%) patients were weaned from support and seven (41.2%) patients were discharged from hospital. Ten (58.8%) patients died while on LVAD support (nine cases) or shortly after weaning (one case). The causes of death in the entire group were cardiac (40%), renal failure (20%), neurologic (10%), sepsis (10%), and multiple organ system failure (20%). The complications were represented by bleeding, renal failure, neurologic event, infection, ventricular arrhythmias, etc. The Luo-Ye VAD functioned well and proved to be useful in patients with postcardiotomy cardiogenic shock. It carries a less-postoperative anticoagulant and a low incidence of VAD-related complications. The survival rate was encouraging in our small cohort of patients. [ABSTRACT FROM AUTHOR]

Aims: More than 20% of patients of 65 years or older may develop a delirium after cardiac surgery. Patients with delirium frequently show a disturbed 24-hr motor activity pattern, but objective and quantitative data are scarce. Our aim was to quantify motor activity patterns in elderly patients with or without a postcardiotomy delirium after elective cardiac surgery. Methods: Wrist-actigraphy was used to quantify 24-hr motor activity patterns for a 5-day period following cardiac surgery in 79 patients of 65 years or older. Clinical state was monitored daily by means of the Confusion Assessment Method-Intensive Care Unit and the Delirium Rating Scale-Revised 98. Results: The activity Amplitude, and the daytime Activity/minute and Restlessness index were significantly higher and the daytime number of Immobility minutes significantly lower for the patients without delirium or with short delirium episodes, as compared to patients with a sustained delirium (>3 days). Conclusions: Actigraphy proves to be a valuable instrument for evaluating motor activity patterns in relation to clinical state in patients with a postcardiotomy delirium. [ABSTRACT FROM AUTHOR]

Study Objective. To determine the effectiveness of intrapleural doxycycline for the treatment of postcardiotomy pleural effusions in pediatric patients. Design. Retrospective case series. Setting. Intensive care unit in a pediatric tertiary care center. Patients. Sequential sample of 12 pediatric patients who underwent cardiotomy for congenital heart disease and received doxycycline pleurodesis for persistent pleural effusion that lasted more than 7 days between December 21, 2001, and May 23, 2005. Measurements and Main Results. Mean age of the patients was 1 year (range 2 wks-2.5 yrs). Eighteen courses of doxycycline were administered among the 12 patients. An average dose of 19.1 mg/kg/dose of parenteral doxycycline was diluted in normal saline to a final syringe concentration of 2-8 mg/ml and injected through a chest tube. The patient was rotated according to a protocol. The doxycycline dose remained in the pleural space for approximately 6 hours before being drained under suction. Treatment success was defined as achievement of 0-ml/hour chest tube output after a doxycycline dose. The overall treatment success rate was 94% (17 of 18 courses). The mean times from dosing to treatment success and chest tube removal were 76 hours (range < 1 to 140 hrs) and 130 hours (range 8-453 hrs), respectively. Seventy-two percent of the courses (13 of 18) achieved treatment success within 96 hours and chest tube removal within 168 hours after dosing. Doxycycline concentration did not appear to be related to treatment success. Chest pain was the most common adverse effect. Conclusion. Intrapleural doxycycline infusion is effective for postcardiotomy pleural effusion in pediatric patients with persistent chest tube drainage lasting more than 7 days. [ABSTRACT FROM AUTHOR]

The incidence of isolated right ventricular (RV) failure is rare in postcardiotomy patients, but high in patients undergoing implantation of a left ventricular assist device or cardiac transplantation. Therefore, we have developed a new microaxial flow device and report on our first in vivo animal trials. Six healthy adult female sheep weighing 80–90 kg underwent implantation of the microaxial blood pump for partial unloading of the right ventricle. This pump is a miniaturized rotary blood pump with a diameter of only 6.4 mm and a weight of 11 g. The inner volume of the pump is limited to 12 mL, and the inner artificial blood contacting surface is 65 cm2. The pump consists of a rotor driven by an incorporated brushless direct current motor, the housing of the rotor, the inflow cage, the outflow cannula, and the driveline. At the maximum speed of 32 500 rotations/min, a flow of 6 L/min can be delivered. The inflow and outflow conduit were anastomosed to the right atrium and the main pulmonary artery, respectively. Hemodynamic and echocardiographic data as well as blood samples were measured over the whole test period of 7 days. The hearts and lungs as well as the pump were explanted for a thorough examination at the end of the trial. Systemic arterial blood pressures remained unchanged during the entire test period. RV cardiac output was diminished significantly as demonstrated by the echocardiographic studies. The number of platelets decreased perioperatively, but recovered within the test period. The free hemoglobin was not enhanced postoperatively indicating no significant hemolysis. Liver function was only slightly impaired due to operative reasons (increase in bilirubin on the first postoperative day but normalization within the test period). The pathologic examination revealed some clots at the inflow cage and fibrin depositions on the impeller as well as on the inner surface of the outflow graft without an impairment of pump function. Our results demonstrate that this newly developed microaxial blood pump is a promising device for RV support, but it cannot be driven without any anticoagulation. [ABSTRACT FROM AUTHOR]

Management of late sternal dehiscence is challenging and time consuming. Although numerous techniques exist including rewiring and titanium plates screwing to stabilize the sternum, we describe an alternative technique by using four titanium clips and one connecting bar. doi: 10.1111/jocs.12123 (J Card Surg 2013;28:632-634) [ABSTRACT FROM AUTHOR]

We report a case of recurrent postcardiac injury syndrome (PCIS) after pacemaker lead insertion. Each episode was attended by hemorrhagic pleuro-pericardial effusion with drop in hemoglobin levels leading us to consider cardiac perforation and subject the patient to surgical pericardiotomy. However, no perforation or active bleeding was detected on exploration. This unusual case illustrates the occurrence of PCIS following pacemaker lead insertion, mimicking cardiac perforation. This entity should be considered in patients who, after pacemaker lead insertion, develop pericardial and pleural effusion associated with markers of inflammation. [ABSTRACT FROM AUTHOR]

Even in infants and small children, ventricular assist devices have an emerging role in the treatment of congenital and postcardiotomy heart failure. Extracorporeal pneumatic pulsatile devices are considered the strategy of choice if long-lasting bridge to recovery or transplantation is expected. However, complete explantation of the device may be complicated by hemorrhage and subsequent transfusions due to the establishment of CPB. The present case demonstrates successful weaning and complete removal of an apical venting pulsatile LVAD in a 4-kg infant without the employment of CPB.(J Card Surg 2005;XX:XXX-XXX) [ABSTRACT FROM AUTHOR]

Background Postpericardiotomy syndrome ( PPS ) is a common complication after cardiac surgery. However, large-scale epidemiological studies about the effect of procedure type on the occurrence of PPS and mortality of patients with PPS have not yet been performed. Methods and Results We studied the association of PPS occurrence with operation type and postoperative mortality in a nationwide follow-up analysis of 28 761 consecutive patients entering coronary artery bypass grafting, aortic valve replacement, mitral valve replacement, or ascending aortic surgery. Only PPS episodes severe enough to result in hospital admission or to contribute as a cause of death were included. Data were collected from mandatory Finnish national registries between 2005 and 2014. Of all the patients included, 493 developed PPS during the study period. The occurrence of PPS was significantly higher after aortic valve replacement (hazard ratio, 1.97; 95% confidence interval, 1.58-2.46; P<0.001), mitral valve replacement (hazard ratio, 1.62; 95% confidence interval, 1.22-2.15; P<0.001), and aortic surgery (hazard ratio, 3.06; 95% confidence interval, 2.24-4.16; P<0.001), when compared with coronary artery bypass grafting in both univariable and multivariable analyses. The occurrence of PPS decreased significantly with aging ( P<0.001). The occurrence of PPS was associated with an increased risk of mortality within the first year after the surgery (adjusted hazard ratio, 1.78; 95% confidence interval, 1.12-2.81; P=0.014). Conclusions The occurrence of PPS was higher after aortic valve replacement, mitral valve replacement, and aortic surgery when compared with the coronary artery bypass grafting procedure. Aging decreased the risk of PPS . The development of PPS was associated with higher mortality within the first year after cardiac or ascending aortic surgery.

In a 78-year old woman, pacemaker implantation was complicated by a transient perforation of the endocardial lead. The patient was in stable condition for up to 7 weeks after implantation, after which pericardial effusion and subacute cardiac tamponade developed and pericardiocentesis became necessary. This case illustrates that even after initially uneventful pacemaker lead perforation, careful, long-term follow-up is necessary to recognize the potential development of late postpericardiotomy syndrome. [ABSTRACT FROM AUTHOR]

Presents a case report of a woman with an erosion of an epicardial pacemaker secondary to postpericardiotomy syndrome. Medical history; Result of chest radiograph; Symptoms of postpercardiotomy syndrome.