VATS treatment of hemothorax and hemopericardium after cardiac surgery

Background:

Postoperative hemothorax and hemopericardium is a common complication after cardiac surgery. The coagulated blood leads to atelectasis, which influence the weaning of the patient and increase the postoperative mortality and morbidity. Due to the fact that it is not a free effusion, the treatment with a chest tube is usually unsuccessful. Re-Sternotomy on the other hand relevantly increases the risk of mediastinitis and sternum instability.

Materials-Methods:

From 2015 to 2018, 21 cases (16 men-5 women) were treated with hemothorax/hemopericardium via thoracoscopy. The cardiac procedure was CABG in 7 cases, MIDCAB in 2 cases, AVR in 2 cases, MVR in 3 cases, MIC-MVR in 2 cases, and combined procedures in 5 cases. The mean age was 70 years. 12 patients had left-sided hemothorax and in 9 patients right-sided. The time interval between heart surgery and VATS was 4 to 54 days. In all cases, a CT thorax was performed prior to the VATS procedure. Three-port VATS was performed in 12 patients and in 9 cases 2-port VATS. In two patients we performed additionally a pericardial window because of hemopericardium. In 10 patients a full VATS pericardial exploration and evacuation of the hematoma was performed.

Results:

None of the patients developed a sternal wound infection. One patient (4.7%) had to undergo sternal rewiring due to sternal instability. One patient was revised for bleeding and two patient were revised due to residual hemothorax. There was no procedure related mortality. Especially the were no complications in the VATS pericardial exploration group despite the delicate operative situs intrapericardially. All patients were discharged a few days after the VATS procedure.

Conclusion:

VATS treatment of hemothorax even in conjunction with a hemopericardium after cardiac surgery is safe. This approach avoids resternotomy with all its consequences and might be recommended as a first approach.