Is there a correlation between late re-exploration after cardiac surgery and removal of epicardial pacemaker wires?

2017-01-25 | journal article, A publication of Göttingen

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​Is there a correlation between late re-exploration after cardiac surgery and removal of epicardial pacemaker wires?​
Bougioukas, I. ; Jebran, A. F. ; Grossmann, M. ; Friedrich, M. ; Tirilomis, T. ; Schoendube, F. A.   & Danner, B. C. ​ (2017) 
Journal of Cardiothoracic Surgery12(3).​ DOI: 

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Bougioukas, Ioannis ; Jebran, Ahmad Fawad ; Grossmann, Marius ; Friedrich, Martin ; Tirilomis, Theodor ; Schoendube, Friedrich A. ; Danner, Bernhard Christoph 
Re-exploration for bleeding accounts for increased morbidity and mortality after major cardiac operations. The use of temporary epicardial pacemaker wires is a common procedure at many departments. The removal of these wires postoperatively can potentially lead to a serious bleeding necessitating intervention. From Jan 2011 till Dec 2015 a total of 4244 major cardiac procedures were carried out at our department. We used temporary epicardial pacemaker wires in all cases. We collected all re-explorations for bleeding and pericardial tamponade from our surgical database and then we focused on the late re-explorations, meaning on the 4th postoperative day and thereafter, trying to identify the removal of the temporary pacemakerwires as the definite cause of bleeding. Patients’ records and medication were examined. Thirty-nine late re-explorations for bleeding, consisting of repeat sternotomies, thoracotomies and subxiphoid pericardial drainages, were gathered. Eight patients had an acute bleeding incidence after removal ofthe temporary wires (0.18%). In four of these patients, a pericardial drainage was inserted, whereas the remaining patients were re-explorated through a repeat sternotomy. Two patients died of the acute pericardial tamponade,three had a blood transfusion and one had a wound infection. Seven out of eight patients were either on dualantiplatelet therapy or on combination of aspirin and vitamin K antagonist. A need for re-exploration due to removal of the temporary pacemaker wires is a very rare complication, which however increases morbidity and mortality. Adjustment of the postoperative anticoagulation therapy at the time of removal of the wires could further minimize or even prevent this serious complication.
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Journal of Cardiothoracic Surgery 



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