Postpericardiotomy Syndrome Incidence, Diagnostic and Treatment Strategies: Experience at Two Collaborative Centers

Gabaldo, Krešimir; Sutlić, Željko; Mišković, Domagoj; Praveček, Marijana Knežević; Prvulović, Đeiti; Vujeva, Božo; Lukenda, Katica Cvitkušić; Hadžibegović, Irzal

doi:10.20471/acc.2019.58.01.08

Cited by 15 publications

(22 citation statements)

References 11 publications

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“…PPS typically occurs within one month after the surgery, and an initial onset after six months is rare [5,12,13,26,[43][44][45][46][47]. In children, the onset is slightly earlier, typically within 1 to 2 weeks [11,33,35].…”

Section: Clinical Features Of Ppsmentioning

confidence: 99%

“…and it occurs in approximately a half of the PPS cases [5,12,43]. The fever is usually the first manifestation.…”

Section: Clinical Features Of Ppsmentioning

confidence: 99%

“…C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are elevated in most PPS patients [4,12,17,22,43,46,[51][52][53], although their specificity is poor during the first weeks after cardiac surgery [56,57]. Other typical laboratory findings include neutrophilic leukocytosis [4,17,49,50,52,53].…”

Section: Clinical Features Of Ppsmentioning

confidence: 99%

“…The thoracic X-ray reveals unilateral (usually left) or bilateral pleural effusion in most of the patients with PPS [5,12,17,43,44,46,50,51,62]. The separation of the pleuritic effusions from the normal surgery-related effusions is however complicated, as >80% of patients have at least minor effusions during the postoperative period [38].…”

Section: Clinical Features Of Ppsmentioning

confidence: 99%

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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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Section: Clinical Features Of Ppsmentioning

confidence: 99%

“…and it occurs in approximately a half of the PPS cases [5,12,43]. The fever is usually the first manifestation.…”

Section: Clinical Features Of Ppsmentioning

confidence: 99%

Section: Clinical Features Of Ppsmentioning

confidence: 99%

Section: Clinical Features Of Ppsmentioning

confidence: 99%

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Postpericardiotomy syndrome after cardiac surgery

Lehto

Kiviniemi

2020

Annals of Medicine

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“…Late-onset pericardial effusion is commonly related to post-pericardiotomy syndrome due to inflammation of the pericardium after a cardiac procedure [8]. Loculated effusions are more common in this patient population because of pericardial adhesions or scarring associated with surgery [6,9].…”

Section: Introductionmentioning

confidence: 99%

Resuscitative transesophageal echocardiography in the diagnosis of post-CABG loculated pericardial clot causing cardiac tamponade

Adi¹,

Ahmad²,

Fong³

et al. 2021

Ultrasound J

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Background Pericardial effusion is a known complication of post-open cardiac surgery which can progress to life-threatening cardiac tamponade. Classical signs of tamponade such as hypotension and pulsus paradoxus are often absent. Diagnosing acute cardiac tamponade with transthoracic echocardiography (TTE) can be challenging in post-cardiac surgical patients due to distorted anatomy and limited scanning windows by the presence of surgical dressings or scar. Additionally, this patient population is more likely to have a loculated pericardial effusion, or an effusion that is isoechoic in appearance secondary to clotted blood. These findings can be challenging to visualize with traditional TTE. Missed diagnosis of cardiac tamponade due to loculated pericardial clot can result in delayed diagnosis and clinical management. Case presentation We report a case series that illustrates the diagnostic challenge and value of resuscitative transesophageal echocardiography (TEE) in the emergency department (ED) for the diagnosis of cardiac tamponade due to posterior loculated pericardial clot in post-surgical coronary artery bypass graft (CABG) patients. Conclusions Cardiac tamponade due to loculated posterior pericardial clot post-CABG requires prompt diagnosis and appropriate management to avoid the potential for hemodynamic instability. Transesophageal echocardiography allows a rapid diagnosis, early appropriate referral and an opportunity to institute appropriate therapeutic measures.

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Early Post-operative ECG Changes as a Predictor of Post-pericardiotomy Syndrome Following Atrial Septal Defect Repair

Hyberg,

El-Assaad,

Liu

et al. 2024

Pediatr Cardiol

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To identify risk factors associated with post-pericardiotomy syndrome (PPS) in patients undergoing surgical repair of atrial septal defects (ASD). A single-center retrospective study. Tertiary academic hospital. Included were patients of all ages who underwent surgical ASD repair, while exclusion criteria included the absence of post-operative electrocardiogram (ECG), lack of follow-up post-discharge and factors hindering ECG interpretation. Demographic and clinical data, including ECG changes indicative of pericardial inflammation, were collected. The primary outcome measure was the development of PPS, determined based on the standardized European Society of Cardiology (ESC) criteria. Among 190 patients who underwent surgical ASD repair, 154 (81%) met the inclusion criteria. Of these, 25 (16%)in total developed PPS, of which 60% were ≥ 18 years of age and 56% female. Significant associations relating both early ECG changes and pre-discharge pericardial effusion with subsequent occurrence of PPS were found in both univariate and multivariate analyses. The study establishes correlations of both early post-operative ECG changes indicative of inflammation and pre-discharge pericardial effusion with subsequent occurrence of PPS in patients undergoing surgical ASD repair. Both utilizing the standardized ESC definition of PPS and incorporating a physician-validated ECG evaluation strengthened the methodologic approach in establishing these relationships. The results also highlight the importance of considering age as a potential risk factor for PPS. Further research is needed to validate these findings and explore additional risk factors predicting early identification and management of patients at high risk for PPS following surgical ASD repairs.

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Postpericardiotomy Syndrome Incidence, Diagnostic and Treatment Strategies: Experience at Two Collaborative Centers

Cited by 15 publications

References 11 publications

Postpericardiotomy syndrome after cardiac surgery

Postpericardiotomy syndrome after cardiac surgery

Resuscitative transesophageal echocardiography in the diagnosis of post-CABG loculated pericardial clot causing cardiac tamponade

Early Post-operative ECG Changes as a Predictor of Post-pericardiotomy Syndrome Following Atrial Septal Defect Repair

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