Pleural Effusion After Endoscopic-Assisted, Minimally Invasive Off-Pump Bypass Grafting

Area of Science:

• Cardiology
• Thoracic Surgery
• Pulmonary Medicine

Background:

• Postoperative pleural effusion (PE) is a frequent complication following endoscopic-assisted, minimally invasive coronary bypass surgery (Endo-CAB).
• Understanding the clinical course and risk factors for PE is crucial for patient management.

Purpose of the Study:

• To evaluate the postoperative course of pleural effusion after Endo-CAB.
• To define a threshold for clinically significant PE.
• To identify independent risk factors associated with PE development.

Main Methods:

• Retrospective analysis of 727 patients undergoing Endo-CAB between May 2021 and January 2026.
• Review of 3141 postoperative chest X-rays to quantify PE, defining clinically significant PE as ≥25% radiographic involvement.
• Logistic regression analysis to identify independent risk factors.

Main Results:

• Pleural effusion occurred in 86.1% of patients, typically within the first two postoperative days, with a median maximum of 13%.
• Most effusions resolved by the third postoperative week.
• Clinically significant PE (≥25%) occurred in 15.4%, associated with longer hospital stay and increased blood transfusion rates.
• Independent risk factors included older age, higher body mass index, continuation of dual antiplatelet therapy, and blood transfusion.

Conclusions:

• Postoperative pleural effusion is a common but generally self-limiting condition after Endo-CAB.
• Clinically significant PE is less common but warrants attention due to associated adverse outcomes.
• Risk stratification may aid in managing patients at higher risk for significant PE.