Complications after cardiac injury ‘can be managed without surgery’
MedWire News: Postdischarge complications occur frequently after cardiac injury, but the majority of these can be managed without surgery, a study suggests.
Nonetheless, all patients who have sustained cardiac injury must undergo echocardiographic evaluation before they are discharged, to assess their risk for complications, report Kenji Inaba (University of Southern California, Los Angeles) and co-authors in the Archives of Surgery.
Their analysis followed 406 patients who sustained penetrating cardiac injuries including stab and gunshot wounds between January 2000 and June 2010, for the primary outcome of cardiac-related complications and mortality.
Cardiac-related complications were defined as decreased ejection fraction (<45%), pericardial effusion, abnormal wall motion, intramural thrombus, cardiac dilation, cardiac pseudoaneurysm, and aneurysm.
Over the 10.5-year follow-up period, 109 (26.9%) patients survived to hospital discharge. A large proportion of these survivors was male (94.4%) with a mean age of 30.8 years. Overall, 74.3% of survivors sustained stab wounds, 22.9% gunshot wounds, and 2.8% shotgun injuries.
The survivors' injuries were located in the right ventricle (45.9%), left ventricle (40.3%), right atrium (10.1%), left atrium (0.9%), and to a lesser extent, in multiple cardiac chambers (2.8%).
Inhospital clinical follow-up data were available for a mean duration of 11 days and outpatient follow-up data was available in 46 patients for a mean duration of 1.9 months. In all, 19 (17.4%) patients had an abnormal echocardiogram. Pericardial effusion was the most common complication, occurring in nine patients. Other complications included valvular injury, conduction abnormality, and septal defect, occurring in four, two, and one patients, respectively. None of the complications required surgical intervention
Further analysis revealed that the respective 1- and 9-year survival rates were 97% and 88%.
In addition, the standardized mortality ratio relative to US normative data was 9.3 at the 9-year follow-up.
In a related commentary, editorialist Martin Schreiber (Oregon Health & Science University, Portland, USA) said it was "unclear" why Tang and team recommend echocardiograms at the 1-month follow-up, as none of the abnormalities found at this point in their study required surgery.
Nonetheless, he commented: "Perhaps the most important point in the article is that complications are common in patients who survive penetrating cardiac injury but few require intervention."
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By Piriya Mahendra