Treatment and Prophylaxis of Post-pericardiotomy Syndrome in Cardiac Surgery Patients: a Systematic Review

Abstract

Purpose Post-pericardiotomy syndrome (PPS) is a common complication of cardiac surgery. This systematic review aimed to investigate the efficacy of colchicine, indomethacin, and dexamethasone in the treatment and prophylaxis of PPS. Methods Literature research was carried out using PubMed. Studies investigating ≥ 10 patients with clinically PPS treated with colchicine, dexamethasone, and indomethacin and compared with placebo were included. Animal or in vitro experiments, studies on < 10 patients, case reports, congress reports, and review articles were excluded. Cochrane risk-of-bias tool for randomized trials (RoB2) was used for the quality assessment of studies. Results Seven studies were included. Among studies with postoperative colchicine treatment, two of them demonstrated a significant reduction of PPS. In the single pre-surgery colchicine administration study, a decrease of PPS cases was registered. Indomethacin pre-surgery administration was linked to a reduction of PPS. No significant result emerged with preoperative dexamethasone intake. Conclusion Better outcomes have been registered when colchicine and indomethacin were administered as primary prophylactic agents in preventing PPS and PE. Further RCT studies are needed to confirm these results.

The effect of stent and decalcification on mitral annular motion after aortic valve replacement

“…These changes in ejection fraction showed recovery or improvement 1 year after the operation. These results suggested that the decline in ejection fraction in patients receiving Inspiris and Intuity was due to adhesion from pericardiotomy and postpericardiotomy syndrome 11 …”

“…These results suggested that the decline in ejection fraction in patients receiving Inspiris and Intuity was due to adhesion from pericardiotomy and postpericardiotomy syndrome. 11 Replacement of the aortic valve with a prosthesis result in alteration of mitral annular motion due to anatomical changes in the aortic-mitral fibrous continuity. 12,13 Previous reports showed that the existence of aortic prosthesis results in a greater reduction in anterior annulus length compared to posterior annulus suggesting mechanical compression by the prosthetic valve.…”