Possible causes of major pleural effusion in early period after cardiac surgery

Safa Göde; Mehmet Yeniterzi; Mehmet Kaya; Muhammet Hulusi Satılmışoğlu; Salih Güler; Mehmet Gül; Serkan Arslan; Mugisha Markior Kyaruzi; Murat Sünbül

doi:10.5606/e-cvsi.2015.406

Cardiovascular Surgery and Interventions 2015, Vol 2, Num 2 Page(s): 021-026

Possible causes of major pleural effusion in early period after cardiac surgery

Safa Göde¹, Mehmet Yeniterzi¹, Mehmet Kaya¹, Muhammet Hulusi Satılmışoğlu¹, Salih Güler¹, Mehmet Gül², Serkan Arslan², Mugisha Markior Kyaruzi¹, Murat Sünbül³

¹Departments of Cardiovascular Surgery, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
²Departments of Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
³Department of Cardiology, Medical Faculty of Marmara University, İstanbul, Turkey

Keywords: Cardiac surgery; chest-X-ray; pleural effusion

Objectives: This study aims to investigate possible causes of major pleural effusion in the early period after cardiac surgery.

Patients and methods: Between January 2012 and June 2012; 72 patients with major pleural effusion study group as confirmed by the chest X-ray two weeks after surgery were included. The control group consisted of 68 age- and sex-matched patients with minor or no effusion. Coronary artery bypass graft (CABG), valve replacement (VR), and CABG in combination with VR, the use of internal mammary artery, total perfusion time (TPT), and aortic cross-clamp time (ACCT) were compared between the two groups. The use of antiaggregants, anticoagulants, and diuretics was analyzed.

Results: The development of pleural effusion was found higher in CABG and CABG in combination with VR patients than only VR patients (p=0.007). Among CABG patients, the development rate of pleural effusion was higher in patients with a mammary artery than those with a non-mammary artery (p=0.043). In study group, TPT (p=0.007) and ACCT (p=0.042) were higher than those without pleural effusion. Logistic regression analysis showed that CABG was responsible for the development of major pleural effusion.

Conclusion: Based on our study results, CABG patients seems to be potential candidates for the development of major pleural effusion compared to VR patients possibly due to pleurotomy, atelectasis, impaired lymphatic drainage, and reduced sternal blood flow. Extended extracorporeal circulation time may also play a role in the development of pleural effusion through inflammatory responses.

DOI : 10.5606/e-cvsi.2015.406