International Society For Minimally Invasive Cardiothoracic Surgery

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Post-pericardiotomy Syndrome In Robotic Tecab: Impact Of Perioperative Steroids
Brooke Patel, Trever Symalla, Mackenzie McCrorey, Husam H. Balkhy.
University of Chicago, Chicago, IL, USA.

BACKGROUND: Post-pericardiotomy syndrome has been reported in 10-40% of all cardiac surgery patients. In spite of a lower incidence of this syndrome in patients undergoing sternal-sparing surgery, we continue to observe it in our beating-heart TECAB patients. The aim of this study is to evaluate if a 6-day steroid taper after TECAB would decrease the incidence and manifestations of post-pericardiotomy syndrome. METHODS: This retrospective study evaluated the outcomes of 100 patients undergoing single and multivessel TECAB from January 2017 to October 2018 in our center. We compared post-operative outcomes of 100 patients who did and did not receive a post-operative steroid taper. STATA software was used to evaluate the effect of steroids on each outcome of interest using multiple linear regression for continuous outcomes and logistic regression for binary outcomes. RESULTS: During the study period, the ‘steroid group' (n=50) were given 100mg of intravenous (IV) Hydrocortisone intra-operatively and a 6-day oral Methylprednisolone taper starting on post-op day 1 with 24mg. The control ‘non-steroid group' (n = 50) did not receive any post-operative steroids after the initial intra-operative IV dose. The groups were similar with respect to gender, age, number of vessels bypassed, STS risk, and operative time. Although mean ICU and hospital lengths of stay trended shorter in the ‘non-steroid' group and the number of patients diagnosed with postoperative pericarditis was lower (1.08 days vs. 1.44 days, p=0.094, and 2.6 days vs. 3.2 days, p=0.062, and 2 patients vs. 6 patients, p=0.099 respectively), none of these outcomes reached statistical significance. Average pain scores, and postoperative complications (including atrial fibrillation, pericardial effusion, pleural effusion, stroke, ARF, MI, readmission, and mortality) showed no significant differences between the groups. Average chest tube drainage was lower and mean glucose level was higher on the first postoperative day in the ‘steroid group' (105, mL vs, 205 mL, p=0.009 and 169 vs 147 p=0.007 respectively). CONCLUSION: In this pilot study of patients undergoing beating-heart TECAB we found a trend of shorter lengths of stay and a decreased incidence of clinical post-pericardiotomy syndrome when postoperative oral steroids were given. Further larger studies are warranted.
Table 1

OutcomeTotalSteroid (n = 50)Non-Steroid (n = 50)P value
ICU Stay (Days)
Hospital Stay (Days)2.922.63.240.062
Pericarditis (n (%))8 (8)2 (4)6 (12)0.099
A-fib (n (%))13 (13)6 (12)7 (14)0.829
Pleural Effusion (n (%))26 (26)9 (18)17 (34)0.215
Average Pain Score (1-10)2.762.952.570.229
ARF (n (%))4 (4)1 (2)3 (6)0.631
Average Glucose POD 1 (#)1581691470.007
CT output POD 1 (mL)1551052050.009

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