Methods
Patient group
From September 2016 until September 2021, surgery registration databases
were retrospectively reviewed for perforation during invasive cardiac
procedures requiring surgical exploration. Cardiac perforation was
defined as the occurrence of a pericardial effusion during or
immediately after the procedure, associated with hemodynamic instability
requiring surgical exploration. 25 consecutive patients were selected; 9
underwent primary full sternotomy, 14 underwent VATS, 2 were converted
from VATS to sternotomy. Baseline characteristics were gender, body mass
index (BMI) and age. Primary outcomes were duration of intensive care
unit (ICU) stay, duration of hospital stay, pericardiocentesis,
cardiopulmonary resuscitation, 30-day mortality and all-round mortality.
Cardiopulmonary resuscitation was defined by active chest compressions
perioperatively due to loss of hemodynamic output. Pericardiocentesis
was defined as percutaneous placement of any form of pericardial
drainage preoperatively.
Surgical method
Surgical method by sternotomy consisted of urgent full sternotomy
followed by opening of the pericardium, central cannulation and surgical
exploration followed by closure of the perforation by purse string
reinforced by teflon felt.
In the thoracoscopy group, three 5mm trocars were placed in either the
left or right axillary region based on the most probable site of the
perforation, after consultation with the cardiologist. Surgical
exploration and inspection after incision of the pericardium was done.
Perforation was closed in the same manner, by purse string reinforced by
teflon felt.
Connection to the extracorporeal circulation (ECC) was by central
cannulation in the sternotomy-group and by femoral cannulation in the
thoracotomy-group. Indications for connection to the ECC were
hemodynamical instability, excessive blood loss or perforation not
accessible on beating heart or with lungs inflated.
Statistical analysis
Baseline study population characteristics by outcome group were
described using proportions for categorical variables and mean ± SD for
continuous variables. Statistical tests were Mann-Whitney-U, Chi-Square
and Fisher’s exact test. A significance level of p < 0.05 was
used. All tests were 2-sided. Statistical analysis was made by SPSS®.
Results