Video-Assisted Thoracoscopy For Penetrating Cardiac Box Injury in Stable Patients

Abstract

Introduction In high-volume trauma centers, especially in developing countries, penetrating cardiac box injuries are frequent. Although many aspects of penetrating chest injuries have been well established, video-assisted thoracoscopy is still finding its place in cardiac box trauma and algorithmic approaches are still lacking. The purpose of this manuscript is to provide a streamlined recommendation for penetrating cardiac box injury in stable patients. Methods Literature review was carried out using PubMed/MEDLINE and Google Scholar databases to identify articles describing the characteristics and concepts of penetrating cardiac box trauma, including the characteristics of tamponade, cardiac ultrasound, indications and techniques of pericardial windows and, especially, the role of video-assisted thoracoscopy in stable patients. Results Penetrating cardiac box injuries, whether by stab or gunshot wounds, require rapid surgical consultation. Unstable patients require immediate open surgery, however, determining which stable patients should be taken to thoracoscopic surgery is still controversial. Here, the classification of penetrating cardiac box injury used in Colombia is detailed, as well as the algorithmic approach to these types of trauma. Conclusion Although open surgery is mandatory in unstable patients with penetrating cardiac box injuries, a more conservative and minimally invasive approach may be undertaken in stable patients. As rapid decision-making is critical in the trauma bay, surgeons working in high-volume trauma centers should expose themselves to thoracoscopy and always consider this possibility in the setting of penetrating cardiac box injuries in stable patients, always in the context of an experienced trauma team.

Predicting mortality in penetrating cardiac trauma in developing countries through a new classification: Validation of the Bogotá classification

“…A fundamental factor to consider is the populations from which these scales have been derived, which are completely different from those within countries where the burden of violence is significantly higher. For instance, the estimated homicide rate per 100,000 habitants during 2019 was 38.28 and 5.77 in Colombia and the US, respectively 28,29 . This wide difference is actually procured by the multiple factors that determine the mortality of patients with PCI, hence a mandatory assessment of the local utility of these classifications through the validation of the formerly described scale, and widely used in our setting (Table 1).…”

“…28 respectively. 28,29 This wide difference is actually procured by the multiple factors that determine the mortality of patients with PCI, hence a mandatory assessment of the local utility of these classifications through the validation of the formerly described scale, and widely used in our setting (Table 1). Spearman correlation and logistic regression corroborated the equivalence of this new classification to the one from Ivatury, as results are consistent with the patient's condition at admission as well as their outcomes.…”

Thirty-five Years of Heart Transplantation in Medellín: Colombia’s First Center for Cardiac Transplantation

“…[2][3][4][8][9][10][11] Despite the country's advances in cardiac surgery (robotics, minimally invasive techniques, and ECMO), the emerging structure of the country has made it challenging to respond to healthcare disparities and coverages. 3,4,[8][9][10][11] The Colombian national transplant network has, however, facilitated minimal waiting times, resulting in swift donor-to-recipient matching and transplantation. In turn, Colombian activities have resulted in an extremely low waiting list mortality.…”

“…7 The emerging nature of our country has led to many challenges: suboptimal care of potential recipients, regular adherence to therapy, socioeconomic difficulties during posttransplant followup, nonreturning patients and traumatic donor deaths have been significant factors influencing transplant survival in Colombia. [2][3][4][8][9][10][11] Many transplant recipients also refuse to live in more urban areas and prefer rural locations, challenging postoperative follow-up with delayed identification of complications, thus impeding prompt intervention. In addition, not all health insurance companies have complied in covering and supplying immunosuppressive drugs.…”

“…The high number of donor deaths caused by gunshot wounds and head trauma reflects unfortunate public health and safety issues endemic to our country while also affecting graft quality and thus recipient survival rates. [2][3][4][8][9][10][11] Despite the country's advances in cardiac surgery (robotics, minimally invasive techniques, and ECMO), the emerging structure of the country has made it challenging to respond to healthcare disparities and coverages. 3,4,[8][9][10][11] The Colombian national transplant network has, however, facilitated minimal waiting times, resulting in swift donor-to-recipient matching and transplantation.…”