title: Is there a correlation between late re-exploration after cardiac surgery and removal of epicardial pacemaker wires?
abstract: BACKGROUND
  Re-exploration for bleeding accounts for increased morbidity and mortality after major cardiac operations. The use of temporary epicardial pacemaker wires is a common procedure at many departments. The removal of these wires postoperatively can potentially lead to a serious bleeding necessitating intervention.
  
  
  METHODS
  From Jan 2011 till Dec 2015 a total of 4244 major cardiac procedures were carried out at our department. We used temporary epicardial pacemaker wires in all cases. We collected all re-explorations for bleeding and pericardial tamponade from our surgical database and then we focused on the late re-explorations, meaning on the 4thpostoperative day and thereafter, trying to identify the removal of the temporary pacemaker wires as the definite cause of bleeding. Patients' records and medication were examined.
  
  
  RESULTS
  Thirty-nine late re-explorations for bleeding, consisting of repeat sternotomies, thoracotomies and subxiphoid pericardial drainages, were gathered. Eight patients had an acute bleeding incidence after removal of the temporary wires (0.18%). In four of these patients, a pericardial drainage was inserted, whereas the remaining patients were re-explorated through a repeat sternotomy. Two patients died of the acute pericardial tamponade, three had a blood transfusion and one had a wound infection. Seven out of eight patients were either on dual antiplatelet therapy or on combination of aspirin and vitamin K antagonist.
  
  
  CONCLUSIONS
  A need for re-exploration due to removal of the temporary pacemaker wires is a very rare complication, which however increases morbidity and mortality. Adjustment of the postoperative anticoagulation therapy at the time of removal of the wires could further minimize or even prevent this serious complication.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center, Robert-Koch 40 Str, 37075, Goettingen, Germany. ybougioukas@yahoo.com.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Bougioukas
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center, Robert-Koch 40 Str, 37075, Goettingen, Germany.
authors.forename: Ahmad Fawad
authors.initials: AF
authors.lastname: Jebran
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center, Robert-Koch 40 Str, 37075, Goettingen, Germany.
authors.forename: Marius
authors.initials: M
authors.lastname: Grossmann
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center, Robert-Koch 40 Str, 37075, Goettingen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Friedrich
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center, Robert-Koch 40 Str, 37075, Goettingen, Germany.
authors.forename: Theodor
authors.initials: T
authors.lastname: Tirilomis
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center, Robert-Koch 40 Str, 37075, Goettingen, Germany.
authors.forename: Friedrich A
authors.initials: FA
authors.lastname: Schoendube
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center, Robert-Koch 40 Str, 37075, Goettingen, Germany.
authors.forename: Bernhard Christoph
authors.initials: BC
authors.lastname: Danner
mesh_terms: D000328:Adult; D000368:Aged; D002304:Cardiac Pacing, Artificial; D006348:Cardiac Surgical Procedures; D002305:Cardiac Tamponade / Q000209:etiology* / Q000401:mortality; D020878:Device Removal / Q000009:adverse effects*; D005260:Female; D005858:Germany; D006470:Hemorrhage / Q000209:etiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation
keywords: Cardiac surgery; Epicardial pacemaker wires; Pericardial tamponade; Re-exploration