Penetrating injuries of the heart and great vessels - fifteen years of experience of the cardiac surgery service as a part of the major trauma centre

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00098892%3A_____%2F18%3AN0000038" target="_blank" >RIV/00098892:_____/18:N0000038 - isvavai.cz</a>

Nalezeny alternativní kódy

RIV/61989592:15110/18:73588333

Výsledek na webu

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DOI - Digital Object Identifier

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Jazyk výsledku

angličtina

Název v původním jazyce

Penetrating injuries of the heart and great vessels - fifteen years of experience of the cardiac surgery service as a part of the major trauma centre

Popis výsledku v původním jazyce

PURPOSE OF THE STUDY. Outcome analysis of penetrating cardiac and great vessels injury within the 15-year existence of the cardiac surgeryservice as a part of the major trauma centre of the University Hospital Olomouc. MATERIAL AND METHODS. Retrospective analysis of a group of a total of 16 patients who underwent a surgery for penetrating cardiac and greatvessels injury since II/2002 to XI/2016. The dominant causes of penetrating trauma were stab injuries (15 patients, 94 %),in one patient only (6 %) it was a gunshot injury. The mean age of the patients included in the group was 42.9 plus minus 16.1 years,with men significantly prevailing (13 patients, 81 %). A total of 7 injured persons (44 %) were haemodynamically stable when admitted, 9 injured persons (56 %) were unstable or in critical condition. The average transfer distance was 48.8 plus minus 34.5 km. The injured were admitted on average 115.9 plus minus 154.8 minutes after being injured. Preoperatively, all the injured suffered from pericardial effusion (above 5 mm) confirmed by TTE (81 %) or CTA (19 %). In 4 patients (25 %) pericardial drainage for cardiac tamponade was performed before surgery. RESULTS All the penetrating cardiac and great vessels injuries were repaired by cardiac surgeon, in one case only (6 %) the extracorporeal circulation support was used. The injury of coronary arteries was in one case managed by CABG and in the other case by ligation of the peripheral part of the coronary artery. In 4 patients (25 %) also a penetrating injury of other organs was simultaneously managed. The mean ICU stay reached 85.8 plus minus 91.9 hours, on average 5.6 plus minus 9.3 units of red blood cells were administered during the in-hospital stay which lasted on average 7.1 plus minus 2.4 days. In the group a non-significant increase of left ventricular ejection fraction (44.1 plus minus 4.7 vs. 49.3 plus minus 3.2, p = 0.882) was reported at discharge of the injured patients. One patient died on the 78th day of hypoxic brain damage (6 % three-month mortality). The long-term survival analysis showed 94 % one-year and 88 % five-year cumulative survival in the group. DISCUSSION. The incidence of the penetrating cardiac and great vessels injury is directly dependent on the crime level in the respektive countries and regions. A cardiac arrest, severe hemodynamic instability, unconsciousness, serious concomitant injury,gunshot injury, multiple or atrial injury represent independent predictors of death in these injuries. The total three-month mortality in penetrating cardiac and great vessels injury ranges from 18 to 42 %, the presence of vital signs at the time of hospital admission is associated with 78–92 % probability of survival. The surviving patients show excellent long-term results with the exception of those who suffered a severe damage to valve apparatus or with significantly depressed left ventricular function.CONCLUSIONS. Our experience proves a high survival rate of patients with penetrating cardiac and great vessels injury. The centralisation of the care into the major trauma centre with a cardiac surgery background, a unified treatment algorithm, and a vital interdisciplinary cooperation are the key goal of successful management of these injuries.

Název v anglickém jazyce

Penetrating injuries of the heart and great vessels - fifteen years of experience of the cardiac surgery service as a part of the major trauma centre

Popis výsledku anglicky

PURPOSE OF THE STUDY. Outcome analysis of penetrating cardiac and great vessels injury within the 15-year existence of the cardiac surgeryservice as a part of the major trauma centre of the University Hospital Olomouc. MATERIAL AND METHODS. Retrospective analysis of a group of a total of 16 patients who underwent a surgery for penetrating cardiac and greatvessels injury since II/2002 to XI/2016. The dominant causes of penetrating trauma were stab injuries (15 patients, 94 %),in one patient only (6 %) it was a gunshot injury. The mean age of the patients included in the group was 42.9 plus minus 16.1 years,with men significantly prevailing (13 patients, 81 %). A total of 7 injured persons (44 %) were haemodynamically stable when admitted, 9 injured persons (56 %) were unstable or in critical condition. The average transfer distance was 48.8 plus minus 34.5 km. The injured were admitted on average 115.9 plus minus 154.8 minutes after being injured. Preoperatively, all the injured suffered from pericardial effusion (above 5 mm) confirmed by TTE (81 %) or CTA (19 %). In 4 patients (25 %) pericardial drainage for cardiac tamponade was performed before surgery. RESULTS All the penetrating cardiac and great vessels injuries were repaired by cardiac surgeon, in one case only (6 %) the extracorporeal circulation support was used. The injury of coronary arteries was in one case managed by CABG and in the other case by ligation of the peripheral part of the coronary artery. In 4 patients (25 %) also a penetrating injury of other organs was simultaneously managed. The mean ICU stay reached 85.8 plus minus 91.9 hours, on average 5.6 plus minus 9.3 units of red blood cells were administered during the in-hospital stay which lasted on average 7.1 plus minus 2.4 days. In the group a non-significant increase of left ventricular ejection fraction (44.1 plus minus 4.7 vs. 49.3 plus minus 3.2, p = 0.882) was reported at discharge of the injured patients. One patient died on the 78th day of hypoxic brain damage (6 % three-month mortality). The long-term survival analysis showed 94 % one-year and 88 % five-year cumulative survival in the group. DISCUSSION. The incidence of the penetrating cardiac and great vessels injury is directly dependent on the crime level in the respektive countries and regions. A cardiac arrest, severe hemodynamic instability, unconsciousness, serious concomitant injury,gunshot injury, multiple or atrial injury represent independent predictors of death in these injuries. The total three-month mortality in penetrating cardiac and great vessels injury ranges from 18 to 42 %, the presence of vital signs at the time of hospital admission is associated with 78–92 % probability of survival. The surviving patients show excellent long-term results with the exception of those who suffered a severe damage to valve apparatus or with significantly depressed left ventricular function.CONCLUSIONS. Our experience proves a high survival rate of patients with penetrating cardiac and great vessels injury. The centralisation of the care into the major trauma centre with a cardiac surgery background, a unified treatment algorithm, and a vital interdisciplinary cooperation are the key goal of successful management of these injuries.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

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OECD FORD obor

30201 - Cardiac and Cardiovascular systems

Projekt

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Návaznosti

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Rok uplatnění

2018

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca

ISSN

0001-5415

e-ISSN

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Svazek periodika

85

Číslo periodika v rámci svazku

2

Stát vydavatele periodika

CZ - Česká republika

Počet stran výsledku

5

Strana od-do

144-148

Kód UT WoS článku

000431090500011

EID výsledku v databázi Scopus

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