Thoracoscopic Talc Pleurodesis for Recurrent, Symptomatic Pleural Effusion Following Cardiac Operations

Abstract

Seventeen patients who underwent a cardiac operation developed a recurrent, symptomatic pleural effusion ultimately requiring video-assisted thoracic surgery (VATS) and talc pleurodesis. These patients represented 0.4% of all patients undergoing a cardiac operation over the same time period. Compared with an age- and sex-matched control group of cardiac surgery patients, patients requiring VATS for recurrent pleural effusion were more obese with higher body mass index (31.9 +/- 1.2 versus 28.3 +/- 1.4 kg/M2, P = 0.03), were more likely to have undergone a complex cardiac operation (8/17 versus 1/17, P =.01) and were more frequently on anticoagulation and antiplatelet agents besides aspirin (8/17 versus 2/17, P =.02). Patients underwent 1.86 +/- 0.34 thoracenteses with drainage of 846 +/- 166 mL/thoracentesis prior to referral for VATS. On average, patients underwent VATS 4.83 +/- 1.49 months after their cardiac operation. There were 3 VATS-related complications (17.6%) and no deaths. VATS talc pleurodesis led to symptomatic and radiologic improvement in all patients with a mean follow-up of 8.2 +/- 1.5 months. VATS talc pleurodesis effectively and safely treats the unusual postcardiac surgery patient with refractory pleural effusion.

The role of video-assisted thoracoscopic surgery for management of symptomatic pleural effusion after coronary artery bypass surgery: a best evidence topic report

“…One patient was still receiving periodic thoracentesis 12 months post-CABG. Paull et al (7) found 17/4,272 (0.4%) patients having PE after cardiac surgery refractory to thoracentesis. All but one of these were successfully treated with VATS pleurodesis.…”

“…All studies but one (8) do not include follow-up, making difficult to define the effectiveness of thoracentesis or chest drainage to resolve PE, as it remains unknown in how many patients an effusion recurs. No case of recurrence was found after a VATS procedure; VATS was a safe procedure with a morbidity of 17% and no mortality (5,7,9). In patients for whom there was a significant delay before proceeding to VATS, it was not unusual to discover a trapped lung (5,7,9) that required in three cases a thoracotomy decortication (2,5,7).…”

“…The present review included two case-series study including ≥4 patients (2,5), 7 retrospective analytical studies (3,4,(7)(8)(9)(10)(11), and one observational study (6) but no randomized controlled trials (RCTs). The score of the level of evidence according to the criteria of Centre for Evidence Based Medicine (CEBM) (12) was low.…”

“…The score of the level of evidence according to the criteria of Centre for Evidence Based Medicine (CEBM) (12) was low. In fact, only one study presented a level of evidence of 2C (6), 7 studies a level of 3b (3,4,(7)(8)(9)(10)(11), and two studies (2,5) a level of 4.…”

“…The management of PE encompassed medical therapy only, thoracentesis, and/ or surgical drainage with or without decortication (2-11). Most of the authors treated early and late PE with thoracentesis or chest drainage (2,3,6,8,10,11), while VATS with pleurodesis was reserved only for patients with PE that persisted after repeating thoracentesis and/or chest drainage (5,7,9). All studies but one (8) do not include follow-up, making difficult to define the effectiveness of thoracentesis or chest drainage to resolve PE, as it remains unknown in how many patients an effusion recurs.…”