Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany.
Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany.
Ann Thorac Surg. 2018 Jun;105(6):1771-1777. doi: 10.1016/j.athoracsur.2018.01.002. Epub 2018 Jan 31.
Ineffective evacuation of intrathoracic fluid after cardiac surgery (retained blood syndrome [RBS]) might increase postoperative complications, morbidity, and mortality. Active tube clearance (ATC) technology using an intraluminal clearing apparatus aims at increasing chest tube drainage efficiency. This study evaluated whether ATC reduces RBS in an all-comers collective undergoing scheduled cardiac surgery with cardiopulmonary bypass and full or partial median sternotomy.
In this nonrandomized prospective trial, 581 consecutive patients undergoing scheduled cardiac surgery with median sternotomy between January 2016 and December 2016 were assigned to receive conventional chest tubes (control group) or a combination of conventional tubes and as many as two ATC devices (ATC group), depending on their operation date. Postoperative occurrence of RBS (one or more of the following: reexploration for bleeding or tamponade, pericardial drainage procedure, pleural drainage procedure) and other endpoints were compared. Propensity score matching was applied.
In 222 ATC patients and 222 matched control patients, RBS occurrence did not differ between the groups (ATC 16%, control 22%; p = 0.15). However, reexploration rate for bleeding or tamponade was significantly reduced in the ATC group compared with the control group (4.1% versus 9.1%, respectively; p = 0.015). The mortality of RBS patients (21%) was higher compared with patients without RBS (3.9%, p < 0.001). Among the RBS components, only reexploration (odds ratio 16, 95% confidence interval: 5.8 to 43, p < 0.001) was relevant for inhospital mortality (ATC 6.8%, control 7.7%; p = 0.71).
Active tube clearance is associated with reduced reexploration rates in an all-comers collective undergoing cardiac surgery. Reexploration is the only RBS component relevant for mortality. The ATC effect does not translate into improved overall survival.
心脏手术后胸腔内液体清除无效（血胸综合征 [RBS]）可能增加术后并发症、发病率和死亡率。使用腔内清除装置的主动管清除（ATC）技术旨在提高胸腔引流效率。本研究评估了在接受体外循环和完全或部分正中劈开胸骨的择期心脏手术的所有患者中，ATC 是否减少 RBS。
在这项非随机前瞻性试验中，2016 年 1 月至 12 月期间，581 例连续接受正中劈开胸骨择期心脏手术的患者被分配接受常规胸腔引流管（对照组）或常规引流管加多达两个 ATC 装置（ATC 组），具体取决于手术日期。比较术后 RBS（以下一项或多项：出血或填塞再探查、心包引流术、胸腔引流术）和其他终点的发生情况。应用倾向评分匹配。
在 222 例 ATC 患者和 222 例匹配的对照组患者中，两组之间 RBS 的发生率没有差异（ATC 组 16%，对照组 22%；p=0.15）。然而，与对照组相比，ATC 组出血或填塞再探查的发生率显著降低（分别为 4.1%和 9.1%；p=0.015）。RBS 患者（21%）的死亡率明显高于无 RBS 患者（3.9%，p<0.001）。在 RBS 成分中，只有再探查（优势比 16，95%置信区间：5.8 至 43，p<0.001）与院内死亡率相关（ATC 组 6.8%，对照组 7.7%；p=0.71）。
在接受心脏手术的所有患者中，主动管清除与降低再探查率相关。再探查是唯一与死亡率相关的 RBS 成分。ATC 的效果不会转化为整体生存率的提高。
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