The Use of Arterial Grafts of the Left Internal Mammary Artery is Not a Predictor for the Incidence of Pericardial Effusion

Slobodan Tomić; Olivera Djokić; Srdjan Babić; Tatjana Raičković; Slobodan Mićović

doi:10.3889/oamjms.2020.3973

Authors

Slobodan Tomić Department of Cardiology, Institute for Cardiovascular Diseases Dedinje, Belgrade, Republic of Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
Olivera Djokić Department of Cardiology, Institute for Cardiovascular Diseases Dedinje, Belgrade, Republic of Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
Srdjan Babić School of Medicine, University of Belgrade, Belgrade, Serbia; Department of Vascular Surgery, Institute for Cardiovascular Diseases Dedinje, Belgrade, Republic of Serbia
Tatjana Raičković Department of Cardiac Surgery, Institute for Cardiovascular Diseases Dedinje, Belgrade, Republic of Serbia
Slobodan Mićović School of Medicine, University of Belgrade, Belgrade, Serbia; Department of Cardiac Surgery, Institute for Cardiovascular Diseases Dedinje, Belgrade, Republic of Serbia

DOI:

https://doi.org/10.3889/oamjms.2020.3973

Keywords:

Pericardial effusion, Left internal mammary artery graft, Venous graft, Coronary surgery

Abstract

BACKGROUND: The left internal mammary artery (LIMA) is used very often for coronary artery bypass grafting (CABG). During the cardiac surgery, surgical preparation of LIMA graft could be the reason for mediastinal bleeding and pericardial effusion (PE).

AIM: This current study was, therefore, undertaken to show the prediction of PE occurrence comparing the usage of LIMA and venous graft.

METHODOLOGY: The study population comprised 1929 patients (1.562 men mean age 57.1 years) who underwent CABG due to coronary disease. Patients were separated into two groups: Patients with venous and patients with arterial grafts on left anterior descending (LAD) artery. The first group included 1468 patients with arterial graft (LIMA) who underwent surgery from October 2008 to January 2014 and the second group included 461 patients with venous graft on LAD that were treated before 2008. Both groups were compared with respect to occurrences, size, and location of PE, which was determined on the 5^thday after surgery by echocardiography.

RESULTS: PE was identified in 1219 (63.1%) patients. There was no difference between compared groups in the proportional occurrence or absence of effusion: In the first group 931 (63.4%) and in the second 288 (62.4%) patients had PE (p > 0.05). There were significant differences (p < 0.001) in localization of effusion; circular effusion was found in 797 (41.3%) patients while localized effusion in 422 (21.8%) patients.

CONCLUSION: Surgical experience can lead to a reduced risk of occurrence of PE when using arterial graft with no differences compared to using a venous graft. The use of arterial LIMA graft is not a predictor for the incidence of PE.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Stevenson LW, Child JS, Laks H, Kern L. Incidence and significance of early pericardial effusions after cardiac surgery. Am J Cardiol. 1984;54(7):848-51. https://doi.org/10.1016/ s0002-9149(84)80219-2 PMid:6486036

Weitzman LB, Tinker WP, Kronzon I, Cohen ML, Glassman E, Spencer FC. The incidence and natural history of pericardial effusion after cardiac surgery an echocardiographic study. Circulation. 1984;69(3):506-11. https://doi.org/10.1161/01. cir.69.3.506 PMid:6692512

Ikäheimo MJ, Huikuri HV, Airaksinen KE, Korhonen UR, Linnaluoto MK, Tarkka MR, et al. Pericardial effusion after cardiac surgery: Incidence, relation to the type of surgery, antithrombotic therapy, and early coronary bypass graft patency. Am Heart J. 1988;116(1 Pt 1):97-102. https://doi. org/10.1016/0002-8703(88)90255-4 PMid:3260740

Pepi M, Muratori M, Barbier P, Doria E, Arena V, Berti M, et al. Pericardial effusion after cardiac surgery: Incidence, site, size, and haemodynamic consequences. Br Heart J. 1994;72(4):327-31. https://doi.org/10.1136/hrt.72.4.327 PMid:7833189

Bateman TM, Czer LS, Gray RJ, Kass RM, Raymond MJ, Garcia EV, et al. Detection of occult pericardial hemorrhage early after open-heart surgery using technetium-99m red blood cell radionuclide ventriculography. Am Heart J. 1984;108(5):1198- 206. https://doi.org/10.1016/0002-8703(84)90742-7 PMid:6496277

Ofori-Krakye SK, Tyberg TI, Geha AS, Hammond GL, Cohen LS, Langou RA. Late cardiac tamponade after open heart surgery: Incidence, role of anticoagulants in its pathogenesis and its relationship to the postpericardiotomy syndrome. Circulation. 1981;63(6):1323-8. https://doi.org/10.1161/01.cir.63.6.1323 PMid:7226478

Ashikhmina EA, Schaff HV, Sinak LJ, Li Z, Dearani JA, Suri RM, et al. Pericardial effusion after cardiac surgery: Risk factors, patient profiles, and contemporary management. Ann Thorac Surg. 2010;89(1):112-8. https://doi.org/10.1016/j. athoracsur.2009.09.026 PMid:20103217

Yilmaz AT, Arslan M, Demirkliç U, Kuralay E, Ozal E, Bingöl H, et al. Late posterior cardiac tamponade after open heart surgery. J Cardiovasc Surg (Torino). 1996;37(6):615-20. PMid:9016978

Konstantinov IE. Robert H. Goetz: The surgeon who performed the first successful clinical coronary artery bypass operation. Ann Thorac Surg. 2000;69(6):1966-72. https://doi.org/10.1016/ s0003-4975(00)01264-9 PMid:10892969

Cameron AA, Green GE, Brogno DA, Thornton J. Internal thoracic artery grafts: 20-year clinical follow-up. J Am Coll Cardiol. 1995;25(1):188-92. https://doi. org/10.1016/0735-1097(94)00332-k PMid:7798499

Singh RN, Sosa JA, Green GE. Internal mammary artery versus saphenous vein graft. Comparative performance in patients with combined revascularisation. Br Heart J. 1983;50(1):48-58. https://doi.org/10.1136/hrt.50.1.48 PMid:6602619

Ali-Hassan-Sayegh S, Mirhosseini SJ, Vahabzadeh V, Ghaffari N. Should the integrity of the pleura during internal mammary artery harvesting be preserved? Interact Cardiovasc Thorac Surg. 2014;19(5):838-47. https://doi.org/10.1093/icvts/ ivu254 PMid:25082837

Jones EL, Weintraub WS, Craver JM, Guyton RA, Cohen CL. Coronary bypass surgery: Is the operation different today? J Thorac Cardiovasc Surg. 1991;101(1):108-15. PMid:1670784

Kuvin JT, Harati NA, Pandian NG, Bojar RM, Khabbaz KR. Postoperative cardiac tamponade in the modern surgical era. Ann Thorac Surg. 2002;74(4):1148-53. https://doi.org/10.1016/ s0003-4975(02)03837-7 PMid:12400760

Spodick DH. The Pericardium a Comprehensive Textbook. New York: Basel-Hong Kong; 1997. p. 7-14.

Spodick DH. The Pericardium a Comprehensive Textbook. New York; Basel-Hong Kong; 1997. p. 15-26.

Viquerat CE, Hansen RM, Botvinick EH, Dae MW, Wiener- Kronish JP, Matthay MA. Undrained bloody pericardial effusion in the early postoperative period after coronary bypass surgery: A prospective blood pool study. Am Heart J. 1985;110(2):335- 41. https://doi.org/10.1016/0002-8703(85)90153-x PMid:3875274

Hochberg MS, Merrill WH, Gruber M, McIntosh CL, Henry WL, Morrow AG. Delayed cardiac tamponade associated with prophylactic anticoagulation in patients undergoing coronary bypass grafting. Early diagnosis with two-dimensional echocardiography. J Thorac Cardiovasc Surg. 1978;75(5):777-81. https://doi.org/10.1016/s0022-5223(19)41332-9 PMid:305985

Merrill W, Donahoo JS, Brawley RK, Taylor D. Late cardiac tamponade: A potentially lethal complication of open-heart surgery. J Thorac Cardiovasc Surg. 1976;72(6):929-32. https:// doi.org/10.1016/s0022-5223(19)40013-5 PMid:1086932

Borkon AM, Schaff HV, Gardner TJ, Merrill WH, Brawley RK, Donahoo JS, et al. Diagnosis and management of postoperative pericardial effusions and late cardiac tamponade following open-heart surgery. Ann Thorac Surg. 1981;31(6):512-9. https://doi.org/10.1016/s0003-4975(10)61340-9 PMid:7247542

Asanza L, Rao G, Voleti C, Hartstein ML, Wisoff BG. Should the pericardium be closed after an open-heart operation? Ann Thorac Surg. 1976;22(6):532-4. https://doi.org/10.1016/ s0003-4975(10)64471-2 PMid:793550

Engle MA, McCabe JC, Ebert PA, Zabriskie J. The Postpericardiotomy syndrome and antiheart antibodies. Circulation. 1974;49(3):401-6. https://doi.org/10.1161/01. cir.49.3.401 PMid:4591546

Ikäheimo M, Takkunen J. Postpericardiotomy syndrome diagnosed by echocardiography. Scand J Thorac Cardiovasc Surg. 1979;13(3):305-8. PMid:542834

Ito T, Engle MA, Goldberg HP. Postpericardiotomy syndrome following surgery for nonrheumatic heart disease. Circulation. 1958;17(4 Part 1):549-56. https://doi.org/10.1161/01.cir.17.4.549 PMid:13523766

Gravanis MB. Cardiovascular Pathophysiology. New York: McGraw-Hill Book Company; 1987. p. 205-25.

Hunter S, Smith GH, Angelini GD. Adverse hemodynamic effects of pericardial closure soon after open heart operation. Ann Thorac Surg. 1992;53(3):425-9. https://doi. org/10.1016/0003-4975(92)90262-3 PMid:1540059

Nandi P, Leung JS, Cheung KL. Closure of pericardium after open heart surgery. A way to prevent postoperative cardiac tamponade. Br Heart J. 1976;38(12):1319-23. https://doi. org/10.1136/hrt.38.12.1319 PMid:795444

Bolao IG, Alegría E, Calabuig J, Llorens R, Navarro C, Iglesias I. Pleuro-pericardial effusion following the early intragraft thrombolysis of an occluded aortocoronary graft. Rev Esp Cardiol. 1992;45(3):222-4. PMid:1574638

Hall TS, Brevetti GR, Skoultchi AJ, Sines JC, Gregory P, Spotnitz AJ. Re-exploration for hemorrhage following open heart surgery differentiation on the causes of bleeding and the impact on patient outcomes. Ann Thorac Cardiovasc Surg. 2001;7(6):352-7. PMid:11888475