Pericardial closure with extracellular matrix scaffold following cardiac surgery associated with a reduction of postoperative complications and 30-day hospital readmissions
Abstract Background A prospective, multi-center study (RECON) was conducted to evaluate the clinical outcomes of pericardial closure using a decellularized extracellular matrix (ECM) graft derived from porcine small intestinal submucosa. Methods Patients indicated for open cardiac surgery with peric...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-03-01
|
| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13019-019-0871-5 |
| _version_ | 1818856009920151552 |
|---|---|
| author | Alfredo Rego Patricia C. Cheung William J. Harris Kevin M. Brady Jeffrey Newman Robert Still |
| author_facet | Alfredo Rego Patricia C. Cheung William J. Harris Kevin M. Brady Jeffrey Newman Robert Still |
| author_sort | Alfredo Rego |
| collection | DOAJ |
| description | Abstract Background A prospective, multi-center study (RECON) was conducted to evaluate the clinical outcomes of pericardial closure using a decellularized extracellular matrix (ECM) graft derived from porcine small intestinal submucosa. Methods Patients indicated for open cardiac surgery with pericardial closure using ECM were eligible for the RECON study cohort. Postoperative complications and readmission of the RECON patients were compared to the patient cohort in the Nationwide Readmissions Database (NRD). Inverse probability of treatment weighting was used to control the differences in patient demographics, comorbidities, and risk factors. Results A total of 1420 patients at 42 centers were enrolled, including 923 coronary artery bypass grafting (CABG) surgeries and 436 valve surgeries. Significantly fewer valve surgery patients in the RECON cohort experienced pleural effusion (3.1% vs. 13.0%; p < 0.05) and pericardial effusion (1.5% vs. 2.6%; p < 0.05) than in the NRD cohort. CABG patients in the RECON cohort were less likely to suffer bleeding (1.2% vs. 2.9%; p < 0.05) and pericardial effusion (0.2% vs. 2.2%, p < 0.05) than those in the NRD cohort. The 30-day all-cause hospital readmission rate was significantly lower among RECON patients than NRD patients following both valve surgery (HR: 0.34; p < 0.05) and CABG surgery (HR: 0.42; p < 0.05). In the RECON study, 14.4% of CABG patients and 27.0% of valve patients had postoperative atrial fibrillation as compared to previously reported risks, which generally ranges from 20 to 30% after CABG and from 35 to 50% after valve surgery. Conclusions Pericardial closure with ECM following cardiac surgery is associated with a reduction in the proportion of patients with pleural effusion, pericardial effusion, and 30-day readmission compared to a nationwide database. Trial registration NCT02073331, Registered on February 27, 2014. |
| first_indexed | 2024-12-19T08:17:41Z |
| format | Article |
| id | doaj.art-79c74edce95f4bdbb1bc7788c231f778 |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-12-19T08:17:41Z |
| publishDate | 2019-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-79c74edce95f4bdbb1bc7788c231f7782022-12-21T20:29:27ZengBMCJournal of Cardiothoracic Surgery1749-80902019-03-0114111010.1186/s13019-019-0871-5Pericardial closure with extracellular matrix scaffold following cardiac surgery associated with a reduction of postoperative complications and 30-day hospital readmissionsAlfredo Rego0Patricia C. Cheung1William J. Harris2Kevin M. Brady3Jeffrey Newman4Robert Still5South Florida Heart & Lung InstituteDepartment of Epidemiology, Emory University Rollins School of Public HealthBaptist Health SystemsSouthwest Heart and LungTenet Health CareBaptist HealthAbstract Background A prospective, multi-center study (RECON) was conducted to evaluate the clinical outcomes of pericardial closure using a decellularized extracellular matrix (ECM) graft derived from porcine small intestinal submucosa. Methods Patients indicated for open cardiac surgery with pericardial closure using ECM were eligible for the RECON study cohort. Postoperative complications and readmission of the RECON patients were compared to the patient cohort in the Nationwide Readmissions Database (NRD). Inverse probability of treatment weighting was used to control the differences in patient demographics, comorbidities, and risk factors. Results A total of 1420 patients at 42 centers were enrolled, including 923 coronary artery bypass grafting (CABG) surgeries and 436 valve surgeries. Significantly fewer valve surgery patients in the RECON cohort experienced pleural effusion (3.1% vs. 13.0%; p < 0.05) and pericardial effusion (1.5% vs. 2.6%; p < 0.05) than in the NRD cohort. CABG patients in the RECON cohort were less likely to suffer bleeding (1.2% vs. 2.9%; p < 0.05) and pericardial effusion (0.2% vs. 2.2%, p < 0.05) than those in the NRD cohort. The 30-day all-cause hospital readmission rate was significantly lower among RECON patients than NRD patients following both valve surgery (HR: 0.34; p < 0.05) and CABG surgery (HR: 0.42; p < 0.05). In the RECON study, 14.4% of CABG patients and 27.0% of valve patients had postoperative atrial fibrillation as compared to previously reported risks, which generally ranges from 20 to 30% after CABG and from 35 to 50% after valve surgery. Conclusions Pericardial closure with ECM following cardiac surgery is associated with a reduction in the proportion of patients with pleural effusion, pericardial effusion, and 30-day readmission compared to a nationwide database. Trial registration NCT02073331, Registered on February 27, 2014.http://link.springer.com/article/10.1186/s13019-019-0871-5Pericardial closureCoronary artery bypass graftingValve repairExtracellular matrixPericardial effusionPleural effusion |
| spellingShingle | Alfredo Rego Patricia C. Cheung William J. Harris Kevin M. Brady Jeffrey Newman Robert Still Pericardial closure with extracellular matrix scaffold following cardiac surgery associated with a reduction of postoperative complications and 30-day hospital readmissions Journal of Cardiothoracic Surgery Pericardial closure Coronary artery bypass grafting Valve repair Extracellular matrix Pericardial effusion Pleural effusion |
| title | Pericardial closure with extracellular matrix scaffold following cardiac surgery associated with a reduction of postoperative complications and 30-day hospital readmissions |
| title_full | Pericardial closure with extracellular matrix scaffold following cardiac surgery associated with a reduction of postoperative complications and 30-day hospital readmissions |
| title_fullStr | Pericardial closure with extracellular matrix scaffold following cardiac surgery associated with a reduction of postoperative complications and 30-day hospital readmissions |
| title_full_unstemmed | Pericardial closure with extracellular matrix scaffold following cardiac surgery associated with a reduction of postoperative complications and 30-day hospital readmissions |
| title_short | Pericardial closure with extracellular matrix scaffold following cardiac surgery associated with a reduction of postoperative complications and 30-day hospital readmissions |
| title_sort | pericardial closure with extracellular matrix scaffold following cardiac surgery associated with a reduction of postoperative complications and 30 day hospital readmissions |
| topic | Pericardial closure Coronary artery bypass grafting Valve repair Extracellular matrix Pericardial effusion Pleural effusion |
| url | http://link.springer.com/article/10.1186/s13019-019-0871-5 |
| work_keys_str_mv | AT alfredorego pericardialclosurewithextracellularmatrixscaffoldfollowingcardiacsurgeryassociatedwithareductionofpostoperativecomplicationsand30dayhospitalreadmissions AT patriciaccheung pericardialclosurewithextracellularmatrixscaffoldfollowingcardiacsurgeryassociatedwithareductionofpostoperativecomplicationsand30dayhospitalreadmissions AT williamjharris pericardialclosurewithextracellularmatrixscaffoldfollowingcardiacsurgeryassociatedwithareductionofpostoperativecomplicationsand30dayhospitalreadmissions AT kevinmbrady pericardialclosurewithextracellularmatrixscaffoldfollowingcardiacsurgeryassociatedwithareductionofpostoperativecomplicationsand30dayhospitalreadmissions AT jeffreynewman pericardialclosurewithextracellularmatrixscaffoldfollowingcardiacsurgeryassociatedwithareductionofpostoperativecomplicationsand30dayhospitalreadmissions AT robertstill pericardialclosurewithextracellularmatrixscaffoldfollowingcardiacsurgeryassociatedwithareductionofpostoperativecomplicationsand30dayhospitalreadmissions |