Controversies in the prophylaxis and treatment of postsurgical pericardial syndromes

Cantinotti, Massimiliano; Spadoni, Isabella; Assanta, Nadia; Crocetti, Maura; Marotta, Marco; Arcieri, Luigi; Murzi, Bruno; Imazio, Massimo

doi:10.2459/jcm.0b013e328362c5b5

Cited by 7 publications

(5 citation statements)

References 35 publications

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“…It occurs in 2–30% of patients after cardiac surgery but may also occur after catheter interventions or other conditions with pericardial damage. In children, NSAIDs such as ibuprofen, diclofenac, indomethacin, and acetylsalicylic acid are established treatments for postpericardiotomy syndrome but should not be used as prophylaxis [ 150 , 151 ].…”

Section: Efficacy Of Nsaidsmentioning

confidence: 99%

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Efficacy and Safety of NSAIDs in Infants: A Comprehensive Review of the Literature of the Past 20 Years

Ziesenitz

Welzel²,

Dyk³

et al. 2022

Pediatr Drugs

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Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in infants, children, and adolescents worldwide; however, despite sufficient evidence of the beneficial effects of NSAIDs in children and adolescents, there is a lack of comprehensive data in infants. The present review summarizes the current knowledge on the safety and efficacy of various NSAIDs used in infants for which data are available, and includes ibuprofen, dexibuprofen, ketoprofen, flurbiprofen, naproxen, diclofenac, ketorolac, indomethacin, niflumic acid, meloxicam, celecoxib, parecoxib, rofecoxib, acetylsalicylic acid, and nimesulide. The efficacy of NSAIDs has been documented for a variety of conditions, such as fever and pain. NSAIDs are also the main pillars of anti-inflammatory treatment, such as in pediatric inflammatory rheumatic diseases. Limited data are available on the safety of most NSAIDs in infants. Adverse drug reactions may be renal, gastrointestinal, hematological, or immunologic. Since NSAIDs are among the most frequently used drugs in the pediatric population, safety and efficacy studies can be performed as part of normal clinical routine, even in young infants. Available data sources, such as (electronic) medical records, should be used for safety and efficacy analyses. On a larger scale, existing data sources, e.g. adverse drug reaction programs/networks, spontaneous national reporting systems, and electronic medical records should be assessed with childspecific methods in order to detect safety signals pertinent to certain pediatric age groups or disease entities. To improve the safety of NSAIDs in infants, treatment needs to be initiated with the lowest age-appropriate or weight-based dose. Duration of treatment and amount of drug used should be regularly evaluated and maximum dose limits and other recommendations by the manufacturer or expert committees should be followed. Treatment for non-chronic conditions such as fever and acute (postoperative) pain should be kept as short as possible. Patients with chronic conditions should be regularly monitored for possible adverse effects of NSAIDs.

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Section: Efficacy Of Nsaidsmentioning

confidence: 99%

“…Recommended doses for different NSAIDs for applications in pediatric cardiology[54,150,151,157,163,[168][169][170][323][324][325][326] …”

mentioning

confidence: 99%

Efficacy and Safety of NSAIDs in Infants: A Comprehensive Review of the Literature of the Past 20 Years

Ziesenitz

Welzel²,

Dyk³

et al. 2022

Pediatr Drugs

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“…However, the use of corticosteroids in the treatment of pericarditis is no longer recommended as it has been associated with higher recurrence rate [15,[153][154][155][156][157]. As stated before, however, evidence against their use in postsurgical pericardial syndromes are scarce [158]. In most of the aforementioned studies, the number of patients using corticosteroids were small, the drug was only administered in case of aspirin contraindications or failure, and the durations of the treatments were relatively short.…”

Section: Medical Treatmentmentioning

confidence: 99%

Postpericardiotomy syndrome after cardiac surgery

Lehto

Kiviniemi

2020

Annals of Medicine

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Postpericardiotomy syndrome (PPS) is a well-known complication after cardiac surgery. The syndrome results in prolonged hospital stay, readmissions, and invasive interventions. Previous studies have reported inconsistent results concerning the incidence and risk factors for PPS due to the differences in the applied diagnostic criteria, study designs, patient populations, and procedure types. In recent prospective studies the reported incidences have been between 21 and 29% in adult cardiac surgery patients. However, it has been stated that most of the included diagnoses in the aforementioned studies would be clinically irrelevant. This challenges the specificity and usability of the currently recommended diagnostic criteria for PPS. Moreover, recent evidence suggests that PPS requiring invasive intervention such as the evacuation of pleural and/or pericardial effusion is associated with increased mortality. In the present review, we summarise the existing literature concerning the incidence, clinical features, diagnostic criteria, risk factors, management, and prognosis of PPS. We also propose novel approaches regarding to the definition and diagnosis of PPS. KEY MESSAGES: 1. Current diagnostic criteria of PPS should be reconsidered, and the analyses should be divided into subgroups according to the severity of the syndrome to achieve more clinically applicable and meaningful results in the future studies. 2. In contrast with the previous presumption, severe PPSdefined as PPS requiring invasive interventionswas recently found to be associated with higher all-cause mortality during the first two years after cardiac surgery. The association with an increased mortality supports the use of relatively aggressive prophylactic methods to prevent PPS. 3. The risk factors clearly increasing the occurrence of PPS are younger age, pleural incision, and valve and ascending aortic procedures when compared to CABG.

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“… 1 – 4 Despite the consequences of PCE, there is little evidence describing risk factors for development or guidance for perioperative management. 5 – 8 …”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] Despite the consequences of PCE, there is little evidence describing risk factors for development or guidance for perioperative management. [5][6][7][8] Reported prevalence of postoperative PCE ranges from 1.1% to 65%, with cardiopulmonary bypass time, atrial septal defect (ASD) repair, genetic abnormalities, and first-time cardiac surgery having been identified as independent risk factors. [9][10][11][12][13][14] However, these published studies are limited to mostly singlecenter reports encompassing various congenital heart disease (CHD) subtypes and surgeries, making the meaningful extrapolation to individual populations difficult.…”

Section: Introductionmentioning

confidence: 99%

Pericardial Effusions After the Arterial Switch Operation: A PHIS Database Review

Mikulski

Well

Subramanian

et al. 2023

World J Pediatr Congenit Heart Surg

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Background: Pericardial effusion (PCE) is a significant complication after pediatric cardiac surgery. This study investigates PCE development after the arterial switch operation (ASO) and its short-term and longitudinal impacts. Methods: A retrospective review of the Pediatric Health Information System database. Patients with dextro-transposition of the great arteries who underwent ASO from January 1, 2004, to March 31, 2022, were identified. Patients with and without PCE were analyzed with descriptive, univariate, and multivariable regression statistics. Results: There were 4896 patients identified with 300 (6.1%) diagnosed with PCE. Thirty-five (11.7%) with PCE underwent pericardiocentesis. There were no differences in background demographics or concomitant procedures between those who developed PCE and those who did not. Patients who developed PCE more frequently had acute renal failure (N = 56 (18.7%) vs N = 603(13.1%), P = .006), pleural effusions (N = 46 (15.3%) vs N = 441 (9.6%), P = .001), mechanical circulatory support (N = 26 (8.7%) vs N = 199 (4.3%), P < .001), and had longer postoperative length of stay (15 [11-24.5] vs 13 [IQR: 9-20] days). After adjustment for additional factors, pleural effusions (OR = 1.7 [95% CI: 1.2-2.4]), and mechanical circulatory support (OR = 1.81 [95% CI: 1.15-2.85]) conferred higher odds of PCE. There were 2298 total readmissions, of which 46 (2%) had PCE, with no difference in median readmission rate for patients diagnosed with PCE at index hospitalization (median 0 [IQR: 0-1] vs 0 [IQR: 0-0], P = .208). Conclusions: PCE occurred after 6.1% of ASO and was associated with pleural effusions and mechanical circulatory support. PCE is associated with morbidity and prolonged length of stay; however, there was no association with in-hospital mortality or readmissions.

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Controversies in the prophylaxis and treatment of postsurgical pericardial syndromes

Cited by 7 publications

References 35 publications

Efficacy and Safety of NSAIDs in Infants: A Comprehensive Review of the Literature of the Past 20 Years

Efficacy and Safety of NSAIDs in Infants: A Comprehensive Review of the Literature of the Past 20 Years

Postpericardiotomy syndrome after cardiac surgery

Pericardial Effusions After the Arterial Switch Operation: A PHIS Database Review

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