Table S1. Summary of the papers.
| Author, date and country, study type (level of evidence) | Patient group | Outcomes | Key results | Comments |
|---|---|---|---|---|
| Kollef et al. (2), Chest 1988, Case series, level 4 | Four patients with symptomatic PEs after CABG using IMA and SVG | Interval from CABG | Range 1–18 months | More aggressive procedures including pleurodesis are indicated if PE persists after repeating thoracentesis |
| Treatment | Repeating thoracentesis (n=3), thoracotomy decortications for trapped lung (n=1) | |||
| Hurlbut et al. (3), Ann Thorac Surg 1990, Retrospective Analytical Study, level 3b | 200 patients underwent CABG (100 with IMA and 100 with SVC) between 1987–1988 were evaluated | Incidence of symptomatic PE | 4/200 (2%). All patients received IMA grafts | The IMA graft seems to result in a small but statistically significant increase in pleuro-pulmonary morbidity as large PE |
| Interval time of PE from CABG | 48 h–8 week | |||
| Treatment | Thoracentesis: 2/4, chest drainage: 2/4 | |||
| Sadikot et al. (4), Arch Intern Med 2000, Retrospective Analytical Study level 3b | 1600 patients undergoing CABG between 1997–1998 were evaluated; 71/1,600 (4.4%) had PEs | Incidence of symptomatic PE | 55/1,600 (3.4%) | Despite the authors did not have controlled data on management of their patients, they suggested that patients with symptomatic PE should be treated with therapeutic thoracentesis. If PE persists more aggressive procedures as tube thoracostomy with pleurodesis should be performed |
| Time of PE from CABG | Early PE (<30 days): 45 pts. Late PE (>30 days): 26 pts | |||
| Characteristics of PEs (early vs. late PE) | All PEs were exudative. Early PE had higher incidence of RBC (P<0.001) and LDH (P<0.001). Late PE had a significant predominance of lymphocytes. | |||
| Lee et al. (5), Chest 2001, Case series, level 4 | The authors evaluated 8 patients undergoing CABG procedure and surgically treated between 1997–1999 for PE that persisted after repeated thoracentesis (n=6) and tube thoracostomy (n=2) | Median interval from CABG and thoracic surgery for PE | 132 (74–2.258) days | Surgical procedures including VATS and thoracotomy are indicated in patients with PE persisting >6 months in order to decorticate any trapped lung and prevent re-accumulation of PE |
| Characteristics of PE | Lymphocytosis (82% to 99%) | |||
| Management | Thoracotomy decortication (n=1), VATS pleurodesis (n=2), VATS decortication (n=3), VATS debridement (n=1), VATS biopsy (n=1) | |||
| Histological findings | Chronic inflammatory process without evidence of specific causes such as malignancy or acute process | |||
| Recurrence | None | |||
| Light et al. (6), Am J RespCrit Care Med 2002, Observational study, level 2c | More than 2,000 patients undergoing cardiac surgery (1,600 CABG) between 1997–1998 were evaluated. Of these 389 had PEs after CABG (n=312); CABG with valve replacement (n=37), and valve replacement (n=40) | Incidence of symptomatic PE at 28 days post-CABG | 34/349: 9.7% | The course of large PE after CABG is relatively benign and PE usually resolved with one or repeated thoracentesis |
| SVG + IMA grafts | 10.6% | |||
| CABG + valve surgery | 13.5% | |||
| Only valve surgery | 15.0% | |||
| SVG versus SVG+IMA | P=0.20 | |||
| 12 months follow-up post-CABG | 30/34 patients available | |||
| Management | No invasive treatment: 8 (27%); single thoracentesis: 16 (53%); 2 thoracentesis: 2 (7%); ≥3 thoracentesis: 4 (13%) | |||
| Paull et al. (7), Surg Lapararosc Endosc Percutan Tech 2003, Retrospective Analytical Study, level 3b | 4,272 patients undergoing cardiac surgery between 1995–2002 were evaluated | Incidence of symptomatic PE | 17/4,272 (0.4%) | Patients with recurrent symptomatic PE not responding to thoracentesis can be safely and effectively treated with VATS talc pleurodesis |
| Interval time of VATS from CABG (LITA graft) | 4.83±1.49 months, range 1–19 months | |||
| Treatment | 17 VATS with pleurodesis (one conversion to thoracotomy) | |||
| Morbidity | 1 congestive heart failure; 1 transient ischemic attack; 1 atrial fibrillation | |||
| Mortality | 0% | |||
| Histological findings | Chronic inflammation: 15/17; fibrosis: 2/17 | |||
| Peng et al. (8), Respirology 2007, Retrospective Analytical Study, level 3b | 356 patients undergoing CABG between 2001–2004 were evaluated | Incidence of symptomatic PE | 11/356 (3%) | Delayed PE after CABG is caused by congestive heart failure. It is usually self-limiting and recurrence is uncommon after thoracentesis |
| SVG only | 3.6% | |||
| SVG plus IMA | 3.3% | |||
| IMA | 1.5% | |||
| Time of PE from CABG | Group 1 (<90 days): 5/11; Group 2 (>90 days): 6/11 | |||
| Characteristics of PEs and echocardiographic patterns (Group 1 vs. Group 2) | Group 2 presented a lower LDH levels (P=0.02) and EF value (P=0.01) | |||
| Treatment | Only one thoracentesis: 10 (91%); chest drainage: 1 (9%) | |||
| Recurrence | None | |||
| Charniot et al. (9), Heart Vessels 2007, Retrospective Analytical Study, level 3b | 512 patients undergoing cardiac surgery (375 CABG) between 2002–2003 were evaluated. Two patients had an off-pump CABG. In three cases, the LITA graft was associated with the opening of the left pleural cavity | Incidence of symptomatic and persistent PE post-CABG | 3/375 (0.8%) | VATS with talc pleurodesis is indicated only in severe cases where PE rapidly recurs after recurring thoracentesis. |
| Management | VATS and talc pleurodesis | |||
| Mean period from CABG to VATS | 80±21.6 days | |||
| Characteristic of fluid | Transudate: 1; exudate: 2 | |||
| Histological findings | Chronic inflammatory process without evidence of specific causes such as malignancy or acute process | |||
| Recurrence | None (median follow-up 16.7±4.5 months) | |||
| Labidi et al. (10), Chest 2009, Retrospective Analytical Study, level 3b | 2,908 patients undergoing cardiac surgery (CABG, valve surgery or simultaneous procedure) between 2004–2005 were evaluated | Incidence of symptomatic PE | 192/2,908 (6.6%) | PE after cardiac surgery increased morbidity and resulted in longer hospital and ICU stays |
| Significant predictive factors of PE | History of peripheral vascular disease (OR: 2.17); use of antiarrhythmic agents (OR: 2.03); surgery length > 30 min (OR: 1.18) and > 60 min (OR: 1.38) | |||
| Treatment | In all cases PEs were drained; 73.8% within first 7 postoperative days; 21% within first postoperative month for recurrent PE | |||
| El Nahal et al. (11), J Egypt Soc Cardiothorac Surg 2009, Retrospective Analytical Study, level 3b | 568 patients underwent CABG between 2005–2008 were evaluated | Incidence of symptomatic PE | Moderate PE: 61 (10.7%); large: 52 (9.1%) | Moderate and/or large symptomatic PE post-CABG should be treated with chest drainage to relieve symptoms and prevent re-accumulation of fluid |
CABG, coronary artery bypass graft; PE, pleural effusion; VATS, video-assisted thoracoscopic surgery; LITA, left internal thoracic artery; pts, patients.