Cote Claudia L, Baghaffar Abdullah, Tremblay Philippe, Herman Christine
Department of Surgery, Division of Cardiac Surgery, Dalhousie University, Halifax, Canada.
J Card Surg. 2020 Jun;35(6):1247-1252. doi: 10.1111/jocs.14564. Epub 2020 Apr 17.
Placement of temporary epicardial pacing wires (TEPW) is common practice in cardiac surgery. Removal of TEPW in the postoperative period can lead to serious bleeding necessitating surgical intervention and conferring high morbidity. The purpose of this study is to determine the incidence of TEPW removal complications.
A retrospective review of all major cardiac operations at our institution from 2005 to 2016 was conducted. Patients were identified using the Maritime Heart Center Database. We reviewed preoperative, intra-operative, and postoperative characteristics of patients who returned to the operating room more than or equal to 3 days after their index operation to identify those who had bleeding and/or tamponade as a consequence of TEPW removal and any subsequent morbidity.
A total of 11 754 patients underwent cardiac surgery at our institution between 2005 and 2016. Of these patients, 88 (0.75%) went back to the operating theater for bleeding and/or tamponade more than or equal to 3 days from their initial index operation. Of these, 11 (0.09%) were secondary to TEPW removal where two (0.017%) suffered irreversible anoxic brain injury. All 11 patients were on antiplatelet therapy with the addition of either deep venous thrombosis (DVT) prophylaxis or therapeutic anticoagulation, which is the standard of care at our institution.
Bleeding complications following TEPW removal are rare but have significant consequences including increased hospital length of stay, resource utilization, and morbidity. Standardized practice to address antiplatelet, DVT prophylaxis, and anticoagulation before removal may help further reduce the incidence of serious bleeding events.
放置临时心外膜起搏导线（TEPW）在心脏手术中是常见操作。术后拔除TEPW可能导致严重出血，需要手术干预且发病率较高。本研究的目的是确定拔除TEPW并发症的发生率。
对我院2005年至2016年所有心脏大手术进行回顾性研究。通过海事心脏中心数据库识别患者。我们回顾了首次手术后3天及以上返回手术室的患者的术前、术中和术后特征，以确定那些因拔除TEPW而出现出血和/或心包填塞以及任何后续发病率的患者。
2005年至2016年期间，我院共有11754例患者接受了心脏手术。其中，88例（0.75%）在首次手术后3天及以上因出血和/或心包填塞返回手术室。其中，11例（0.09%）继发于TEPW拔除，其中2例（0.017%）发生不可逆的缺氧性脑损伤。所有11例患者均接受抗血小板治疗，并加用深静脉血栓形成（DVT）预防或治疗性抗凝，这是我院的标准治疗方案。
拔除TEPW后的出血并发症罕见，但后果严重，包括住院时间延长、资源利用增加和发病率上升。在拔除前处理抗血小板、DVT预防和抗凝的标准化操作可能有助于进一步降低严重出血事件的发生率。
