Increased Inflammation in Pericardial Fluid Persists 48 Hours After Cardiac Surgery

Butts, Brittany; Goeddel, Lee A.; George, David J.; Steele, Chad; Davies, James E.; Wei, Chih Chang; Varagić, Jasmina; George, James F.; Ferrario, Carlos M.; Melby, Spencer J.; Dell’Italia, Louis J.

doi:10.1161/circulationaha.117.029589

Cited by 42 publications

(22 citation statements)

References 5 publications

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“…There is a growing body of literature linking chest tube clogging and retained blood around the heart in the triggering of POAF in susceptible individuals by promoting both local inflammatory and oxidative responses on the surface of the heart during early recovery [ 6 – 9 , 21 , 22 ]. The prospect of blunting this reaction by preventing blood from pooling around the heart with the simple addition of an ATC device is particularly appealing considering the steady incidence of POAF over the past decades despite pharmacological prophylaxis and the increased mortality and higher health care expenditure associated with this arrhythmia [ 23 – 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Intrathoracic retention of shed blood may lead to cardiac tamponade requiring re-exploration or bloody effusions for which an invasive drainage procedure may become necessary [3][4][5]. Additionally, retained blood within the pericardium may promote both local proinflammatory and oxidative responses which are potent triggers for postoperative atrial fibrillation (POAF) and bloody effusions in susceptible individuals [6][7][8][9]. Meanwhile, although routinely used, traditional makeshift methods to clear visible clots like milking and stripping of tubes remain controversial as they present several practical and safety issues [10,11].…”

Section: Introductionmentioning

confidence: 99%

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Active clearance vs conventional management of chest tubes after cardiac surgery: a randomized controlled study

St-Onge

Chauvette

Hamad

et al. 2021

J Cardiothorac Surg

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Background Chest tubes are routinely used after cardiac surgery to evacuate shed mediastinal blood. Incomplete chest drainage due to chest tube clogging can lead to retained blood after cardiac surgery. This can include cardiac tamponade, hemothorax, bloody effusions and postoperative atrial fibrillation (POAF). Prior published non randomized studies have demonstrated that active tube clearance (ATC) of chest tubes can reduce retained blood complications prompting the ERAS Cardiac Society guidelines to recommend this modality. Objective A randomized prospective trial to evaluate whether an ATC protocol aimed at improving chest tube patency without breaking the sterile field could efficiently reduce complications related to retained blood after cardiac surgery. Methods This was a pragmatic, single-blinded, parallel randomized control trial held from November 2015 to June 2017 including a 30-day post index surgery follow-up. The setting was two academic centers affiliated with the Université de Montréal School of Medicine; the Montreal Heart Institute and the Hôpital du Sacré-Coeur de Montréal. Adult patients admitted for non-emergent coronary bypass grafting and/or valvular heart surgery through median sternotomy, in sinus rhythm for a minimum of 30 days prior to the surgical intervention were eligible for inclusion. In the active tube clearance group (ATC), a 28F PleuraFlow device was positioned within the mediastinum. In the standard drainage group, a conventional chest tube (Teleflex Inc.) was used. Other chest tubes were left at the discretion of the operating surgeon. Results A total of 520 adult patients undergoing cardiac surgery were randomized to receive either ATC (n = 257) or standard drainage (n = 263). ATC was associated with a 72% reduction in re-exploration for bleeding (5.7% vs 1.6%, p = .01) and an 89% reduction in complete chest tube occlusion (2% vs 19%, p = .01). There was an 18% reduction in POAF between the ATC and control group that was not statistically significant (31% vs 38%, p = .08). Conclusions and relevance In this RCT, the implementation of active clearance of chest tubes reduced re-exploration and chest tube clogging in patients after cardiac surgery further supporting recommendations to consider this modality postoperatively. Trial registration Clinical Trials NCT02808897. Retrospectively registered 22 June 2016.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Active clearance vs conventional management of chest tubes after cardiac surgery: a randomized controlled study

St-Onge

Chauvette

Hamad

et al. 2021

J Cardiothorac Surg

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“…7) It has been shown that in injured hearts of mice and men resident and circulating leukocytes can be activated any form of injury such as in infarction (20) or after cardiac surgery (21).…”

Section: Lessons Learned From Animal Studiesmentioning

confidence: 99%

Cardio-Immunology of Myocarditis: Focus on Immune Mechanisms and Treatment Options

Maisch

2019

Front. Cardiovasc. Med.

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Myocarditis and inflammatory cardiomyopathy are syndromes, not aetiological disease entities. From animal models of cardiac inflammation we have detailed insight of the strain specific immune reactions based on the genetic background of the animal and the infectiosity of the virus. Innate and adaptive immunity also react in man. An aetiological diagnosis of a viral vs. a non-viral cause is possible by endomyocardial biopsy with histology, immunohistology and PCR for microbial agents. This review deals with the different etiologies of myocarditis and inflammatory cardiomyopathy on the basis of the genetic background and the predisposition for inflammation. It analyses the epidemiologic shift in cardiotropic viral agents in the last 30 years. Based on the understanding of the interaction between infection and the players of the innate and adaptive immune system it summarizes pathogenetic phases and clinical faces of myocarditis. It gives an up-to-date information on specific treatment options beyond symptomatic heart failure and antiarrhythmic therapy. Although inflammation can resolve spontaneously, specific treatment directed to the causative etiology is often required. For fulminant, acute, and chronic autoreactive myocarditis without viral persistence immunosuppressive treatment can be life-saving, for viral inflammatory cardiomyopathy ivIg treatment can resolve inflammation and often eradicate the virus.

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“…The surface of the heart is covered with a membranous structure called the pericardium, which is mainly composed of the epicardium, pericardial cavity, parietal layer of serous and fibrous layer 61 . Under steady state, serous cavities with the protective serosal fluid harbour large numbers of immune cells, such as macrophages, B cells and so on, and as a result, it may be one of a source of tissue‐infiltrating leucocytes during pathological conditions 62,63 . Pericardial adipose tissue (AT) is an abundant source of leucocytes, such as B, T, dendritic cells and myeloid cells 64 .…”

Section: Ilcs In Cardiovascular Systemmentioning

confidence: 99%

Friend or foe of innate lymphoid cells in inflammation‐associated cardiovascular disease

Gong

Xia

2020

Immunology

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Increased Inflammation in Pericardial Fluid Persists 48 Hours After Cardiac Surgery

Cited by 42 publications

References 5 publications

Active clearance vs conventional management of chest tubes after cardiac surgery: a randomized controlled study

Active clearance vs conventional management of chest tubes after cardiac surgery: a randomized controlled study

Cardio-Immunology of Myocarditis: Focus on Immune Mechanisms and Treatment Options

Friend or foe of innate lymphoid cells in inflammation‐associated cardiovascular disease

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