Diagnosis and Management of Postoperative Pericardial Effusions and Late Cardiac Tamponade Following Open-Heart Surgery

Borkon, A. Michael; Schaff, Hartzell V.; Gardner, Timothy J.; Merrill, Walter H.; Brawley, Robert K.; Donahoo, James S.; Watkins, Levi; Weiss, James L.; Gott, Vincent L.

doi:10.1016/s0003-4975(10)61340-9

Cited by 62 publications

(22 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In particular, delayed cardiac tamponade may develop silently in the absence of obvious clinical signs. Because it can be easily missed, and without early diagnosis and treatment, can be life threatening, early decompression is required as soon as its presence is confirmed [22,23]. Among the study population, there was no fatal event due to cardiac tamponade following timely intervention.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Predictors, and Clinical Outcomes of Postoperative Cardiac Tamponade in Patients Undergoing Heart Valve Surgery

et al. 2016

View full text Add to dashboard Cite

This study aimed to investigate the incidence, predictors, and clinical outcomes of cardiac tamponade after heart valve surgery. A total of 556 patients who underwent heart valve surgery in a single tertiary center between January 2010 and March 2012 were studied. All patients underwent transthoracic echocardiography (TTE) about 5 days after surgery and TTE was repeated regularly. Patients with suspected acute pericardial hemorrhage were excluded. Cardiac tamponade occurred in twenty-four (4.3%) patients and all underwent surgical or percutaneous pericardial drainage. The median time of pericardial drainage after surgery was 17 (interquartile range, IQR, 13–30) days. Infective endocarditis, mechanical valve replacement of aortic or mitral valve, and any amount of pericardial effusion (PE) on the first postoperative TTE were related to the occurrence of cardiac tamponade (all p<0.05). After multivariate adjustment, occurrence of cardiac tamponade was associated with any amount of PE on the first postoperative TTE (hazard ratio, HR, 14.00, p<0.001) and mechanical valve replacement (HR 2.69, p = 0.025). The mean hospital days in patients with cardiac tamponade was higher than those without (34.9 vs. 13.5, p = 0.031). After pericardial drainage, there was no echocardiographic recurrence of significant PE during a median of 34.8 (IQR 14.9–43.7) months after surgery. Cardiac tamponade after heart valve surgery is not uncommon. Patients with any amount of PE at the first postoperative TTE or mechanical valve replacement should receive higher attention with regard to the occurrence of cardiac tamponade. Although it prolongs hospital stay, cardiac tamponade exhibits a benign clinical course without recurrence after timely intervention.

show abstract

Section: Discussionmentioning

confidence: 99%

Incidence, Predictors, and Clinical Outcomes of Postoperative Cardiac Tamponade in Patients Undergoing Heart Valve Surgery

et al. 2016

View full text Add to dashboard Cite

show abstract

“…This procedure remains the treatment of choice if percutaneous pericardiocentesis is unsuccessful, or for recurrent effusions. However, these situations arise in only a small proportion of patients [6,34,41]. Our series includes reaccumulation in only one patient.…”

Section: Treatmentmentioning

confidence: 93%

Experience with cardiac tamponade following open heart surgery

Ball

Morrison

1996

Heart Vessels

View full text Add to dashboard Cite

Cardiac tamponade following open heart surgery is well described, although, fortunately, uncommon. Unlike more classical "primary" tamponade, the clinical features are not specific, and this can delay diagnosis. In practice, the threshold for investigation must be low, and echocardiography has been invaluable in the detection and localization of pericardial collections. Several factors are believed to contribute to the likelihood of postoperative tamponade, but the mechanisms are not clearly understood. Resternotomy, under general anesthesia, or subxiphoid pericardiotomy, under local or general anesthesia, are effective forms of treatment. However, recent success with the use of percutaneous pericardiocentesis under echocardiographic guidance has shown that postoperative tamponade can be treated safely and effectively by this method.

show abstract

“…In patients presenting with moderate or large pericardial effusions or echocardiographic signs of cardiac tamponade, echocardiography was performed daily (postoperative day [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. The decision to perform percutaneous or surgical pericardiocentesis was based on clinical evidence of raised venous pressure, hypotension and pulsus paradoxus.…”

Section: Methodsmentioning

confidence: 99%

Pericardial effusion after cardiac surgery: incidence, site, size, and haemodynamic consequences.

Pepi

Muratori

Barbier

et al. 1994

Heart

176

115

View full text Add to dashboard Cite

show abstract

Diagnosis and Management of Postoperative Pericardial Effusions and Late Cardiac Tamponade Following Open-Heart Surgery

Cited by 62 publications

References 20 publications

Incidence, Predictors, and Clinical Outcomes of Postoperative Cardiac Tamponade in Patients Undergoing Heart Valve Surgery

Incidence, Predictors, and Clinical Outcomes of Postoperative Cardiac Tamponade in Patients Undergoing Heart Valve Surgery

Experience with cardiac tamponade following open heart surgery

Pericardial effusion after cardiac surgery: incidence, site, size, and haemodynamic consequences.

Contact Info

Product

Resources

About