Muhammet Onur HANEDAN, Adnan YALÇINKAYA, Gökhan LAFÇI, Ömer Faruk ÇİÇEK, Emre YAŞAR, Ersin KADİROĞULLARI, Garip ALTINTAŞ, Adem İlkay DİKEN

A comparison of two surgical techniques for symptomatic pericardial effusion after cardiac surgery: subxiphoid open pericardial drainage and lateral thoracotomy

Amaç: Bu çalışmada açık kalp cerrahisi sonrası semptomatik perikardiyal efüzyonlu hastalarda en sık kullanılan iki cerrahi tekniğin sonuçları karşılaştırıldı.Çalışma planı: Eylül 2004 - Eylül 2012 tarihleri arasında, kliniğimizde açık kalp cerrahisi yapılan 14.390 hastanın verileri retrospektif olarak analiz edildi. Toplam 152 hasta bu çalışmaya dahil edildi ve uygulanan tedavi yöntemine göre iki gruba ayrıldı. Subksifoid perikardial drenaj 86 hastaya (%56.6) (grup 1), yan torakotomi ile perikardiyal pencere açılması 66 hastaya (%43.4) uygulandı (grup 2). Bu hastalar içerisinde semptomatik perikardiyal efüzyon gelişmiş olan ve subksifoid perikardiyal drenaj veya yan torakotomi yöntemi ile yeniden eksplore edilen hastalar analiz edildi. Ameliyat sırası veriler, ameliyata bağlı ve 30 günlük hastane mortaliteleri açısından karşılaştırıldı.Bul gu lar: Grup 2'de ameliyat tekniği tam bir başarıya ulaşmışken (%100), grup 1'de başarı oranı %87.2 idi (p< 0.003). Lokal anestezi, grup 1'de 73 hastada (%84.9) tercih edildi ve ameliyat süresinin daha kısa olduğu tespit edildi (p< 0.001). Grup 1'de dört hasta (%4.7) ameliyat masasında kaybedilmesine rağmen, ameliyata bağlı mortalitede gruplar arasında istatistiksel olarak anlamlı fark bulunamadı (p=0.133). Grup 1'deki teknik başarısızlığın mortalite oranında artışa yol açtığı tespit edildi (%36.4) (p< 0001).So nuç: Subksifoid işlem hızlı ve kolay yapılsa da teknik başarısızlık nadir değildir ve yüksek mortalite oranına sahiptir

Kardiyak cerrahi sonrası semptomatik perikardiyal efüzyonlu hastalarda iki cerrahi tekniğin karşılaştırılması: Subksifoid açık perikardiyal drenaj ve yan torakotomi

Background: This study aims to compare the outcomes of the two most common surgical techniques applied in patients with symptomatic pericardial effusion following open heart surgery. Methods: Between September 2004 and September 2012, we retrospectively analyzed the data of 14,390 patients who underwent open heart surgery in our clinic. A total of 152 patients were included and divided into two groups, according to treatment modality applied. Subxiphoid pericardial drainage was performed in 86 patients (56.6%) (group 1) and pericardial window opening via lateral thoracotomy was performed in 66 patients (43.4%) (group 2). We further analyzed the patients who underwent surgical reexploration due to symptomatic pericardial effusion via lateral thoracotomy or subxiphoid procedure. Perioperative outcomes were compared in terms of operative and 30-day in-hospital mortality. Results: In group 2, operative technique produced a complete success (100%), whereas the success rate was 87.2% in group 1 (p< 0.003). Local anesthesia was preferred in 73 patients (84.9%) in group 1 and shorter operation times were observed (p< 0.001). Although four patients (4.7%) died in the operating room in group 1, there was no statistically significant difference in operative mortality between the groups (p=0.133). Technical failure in group 1 led to increased mortality rates (36.4%) (p< 0001). Conclusion: Although subxiphoid procedure can be performed rapidly with ease, technical failure is not rare and may be associated with high mortality rates

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