Abstract
ObjectivesPleural effusions appearing within the first 30 postoperative days following coronary artery bypass grafting (CABG) are classified as early and believed to be directly related to the surgery. The characteristics of such effusions are well-described. Orthotopic heart transplantation is also known to be complicated by pleural effusions; however, their characteristics have not been systematically reported. We assessed the features of early postoperative pleural effusions after heart transplantation and compared them to those of early effusions following CABG.MethodsWe retrospectively collected demographic, clinical, and laboratory data for patients who underwent either orthotopic heart transplantation (study group) or CABG (comparison group) at our institution and whose postoperative course within 30 days was complicated by new or worsening pleural effusion that prompted drainage. Patients subjected to analysis consisted only of those with sufficiently complete laboratory profiles to permit adequate characterization of the nature of their pleural fluid.ResultsOut of 251 orthotopic heart transplant recipients, seven (2.8%) were found to have sufficiently complete pleural fluid results to be included in the study group. Out of 1,506 patients who underwent CABG, 32 (2.1%) had sufficiently complete pleural fluid results and formed the comparison group. The radiological appearance of pleural effusions in both groups was similar: bilateral in at least half and exclusively moderate to large. Effusions complicating both surgeries were exudative in close to 90% of cases. For those with available leukocyte differential counts, the pleural fluid of the post-orthotopic heart transplantation group was more often neutrophilic (3/5, 60%), whereas the fluid of the post-coronary artery bypass grafting group was more often lymphocytic (22/32, 69%) and tended to be hemorrhagic (median RBC count 33,000 cells/µL vs. 10,000 cells/µL). None of the comparisons of pleural fluid characteristics between the two groups reached statistical significance.ConclusionsThis small, descriptive study is the first to systematically report the fluid characteristics of pleural effusions complicating orthotopic heart transplantation within the first 30 postoperative days and to compare this group to those who developed effusions after CABG. Our findings revealed both similarities and differences in the pleural fluid characteristics between these two types of patients.
Highlights
Coronary artery bypass grafting (CABG) is a common operation in the United States with an estimated 400,000 procedures performed annually [1]
Post-Orthotopic heart transplantation (OHT) pleural effusions have been characterized in general terms by prior investigators [5, 6], very little data exist about the pleural fluid (PF) characteristics of these effusions
It was decided a priori that patients would be excluded if available thoracic imaging prior to OHT revealed an ipsilateral pleural effusion that was of equal size or larger than the sampled post-operative effusion
Summary
Coronary artery bypass grafting (CABG) is a common operation in the United States with an estimated 400,000 procedures performed annually [1]. Incising the pleura during harvesting of the internal mammary artery (IMA) is thought to increase the incidence of post-CABG pleural effusion, but pleural incision is not a consistent risk factor, implying a multifactorial process [4]. It is not surprising, that pleural effusions are known to complicate cardiac surgery that does not involve traversing the pleural space. Of particular interest are early effusions detected during the first 30 postoperative days and more likely to be related to the antecedent operation than to medical complications of OHT. The present study compares the PF characteristics of post-OHT patients who underwent sampling of a new or worsening pleural effusion within 30 days after surgery to those of postCABG patients meeting the same criteria
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
