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1.
Acta Clin Croat. 2019 Mar;58(1):57-62. doi: 10.20471/acc.2019.58.01.08.

Postpericardiotomy syndrome incidence, diagnostic and treatment strategies: experience AT two collaborative centers.

Author information

1
1Cardiology Department, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia; 2Department of Cardiac Surgery, Dubrava University Hospital, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Department of Cardiology, Dubrava University Hospital, Zagreb, Croatia; 5Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.

Abstract

Postpericardiotomy syndrome (PPS) is worsening or new formation of pericardial and/or pleural effusion mostly 1 to 6 weeks after cardiac surgery, as a result of autoimmune inflammatory reaction within pleural and pericardial space. Its incidence varies among different studies and registries (2% to 30%), as well as according to the type of cardiac surgery performed. We conducted this retrospective analysis of PPS incidence and diagnostic and treatment strategies in patients referred for cardiac surgery for revascularization, valvular and/or aortic surgery. We retrospectively analyzed 461 patients referred for an urgent or elective cardiac surgery procedure between 2009 and 2015. PPS diagnosis was established using well defined clinical criteria. Demographic and clinical characteristics were used in regression subanalysis among patients having undergone surgery of aortic valve and/or ascending aorta. Within 6 weeks after cardiac surgery, 47 (10.2%) patients had PPS. The median time from the procedure to PPS diagnosis was 14 days. The incidence of PPS was 26% after aortic valve and/or aorta surgery, and 7.9% and 8.3% after coronary bypass and mitral valve surgery, respectively. Among patients subjected to aortic valve and/or aortic surgery, regression analysis showed significant association of fever, C-reactive protein (CRP) elevation between 5 and 100 mg/L, urgent procedure and postoperative antibiotic use with PPS diagnosis, whereas younger age showed near-significant association. All patients had complete resolution of PPS, mostly after corticosteroid therapy, with only 2 cases of recurrent PPS that successfully resolved after colchicine therapy. Pleural drainage was indicated in 15 (32%) patients, whereas only one patient required pericardial drainage. In conclusion, PPS incidence in our retrospective analysis was similar to previous reports. Patients having undergone aortic valve and/or aortic surgery were most likely to develop PPS. The most relevant clinical criteria for diagnosis in these patients were fever, CRP elevation between 5 and 100 mg/L, and pericardial and/or pleural effusion formation or worsening 2 weeks after cardiac surgery.

KEYWORDS:

Cardiac surgical procedures; Pericardial effusion; Pleural effusion; Postoperative complications; Postpericardiotomy syndrome

PMID:
31363326
PMCID:
PMC6629199
DOI:
10.20471/acc.2019.58.01.08
[Indexed for MEDLINE]
Free PMC Article
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2.
J Am Heart Assoc. 2018 Nov 20;7(22):e011118. doi: 10.1161/JAHA.118.011118.

Post-Pericardiotomy Syndrome: Beware or Just Be Aware?

Author information

1
1 Department of Cardiothoracic Surgery and Department of Transcatheter Heart Valves Hygeia Hospital Athens Greece.
2
2 Division of Cardiothoracic Surgery Baylor College of Medicine Michael E DeBakey VA Medical Center Houston TX.

Abstract

See Article by Lehto et al .

KEYWORDS:

Editorial; pericarditis; pericardium; surgery

PMID:
30571507
PMCID:
PMC6404453
DOI:
10.1161/JAHA.118.011118
[Indexed for MEDLINE]
Free PMC Article
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3.
J Am Heart Assoc. 2018 Nov 20;7(22):e010269. doi: 10.1161/JAHA.118.010269.

Occurrence of Postpericardiotomy Syndrome: Association With Operation Type and Postoperative Mortality After Open-Heart Operations.

Author information

1
1 Heart Center Turku University Hospital Turku Finland.
2
3 University of Turku Finland.
3
2 Clinical Research Center Turku University Hospital Turku Finland.
4
4 Department of Public Health University of Turku Finland.
5
5 Research Center of Applied and Preventive Cardiovascular Medicine University of Turku Finland.

Abstract

Background Postpericardiotomy syndrome ( PPS ) is a common complication after cardiac surgery. However, large-scale epidemiological studies about the effect of procedure type on the occurrence of PPS and mortality of patients with PPS have not yet been performed. Methods and Results We studied the association of PPS occurrence with operation type and postoperative mortality in a nationwide follow-up analysis of 28 761 consecutive patients entering coronary artery bypass grafting, aortic valve replacement, mitral valve replacement, or ascending aortic surgery. Only PPS episodes severe enough to result in hospital admission or to contribute as a cause of death were included. Data were collected from mandatory Finnish national registries between 2005 and 2014. Of all the patients included, 493 developed PPS during the study period. The occurrence of PPS was significantly higher after aortic valve replacement (hazard ratio, 1.97; 95% confidence interval, 1.58-2.46; P<0.001), mitral valve replacement (hazard ratio, 1.62; 95% confidence interval, 1.22-2.15; P<0.001), and aortic surgery (hazard ratio, 3.06; 95% confidence interval, 2.24-4.16; P<0.001), when compared with coronary artery bypass grafting in both univariable and multivariable analyses. The occurrence of PPS decreased significantly with aging ( P<0.001). The occurrence of PPS was associated with an increased risk of mortality within the first year after the surgery (adjusted hazard ratio, 1.78; 95% confidence interval, 1.12-2.81; P=0.014). Conclusions The occurrence of PPS was higher after aortic valve replacement, mitral valve replacement, and aortic surgery when compared with the coronary artery bypass grafting procedure. Aging decreased the risk of PPS . The development of PPS was associated with higher mortality within the first year after cardiac or ascending aortic surgery.

KEYWORDS:

epidemiology; mortality; pericardium; postpericardiotomy syndrome; thoracic surgery

PMID:
30571490
PMCID:
PMC6404434
DOI:
10.1161/JAHA.118.010269
[Indexed for MEDLINE]
Free PMC Article
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4.
Eur Heart J. 2017 Jun 7;38(22):1706-1709. doi: 10.1093/eurheartj/ehx246.

Colchicine in Pericarditis.

Author information

1
Corresponding author Head, Heart Institute Hospital Universitari Germans Trias i Pujol Badalona, Spain, & Department of Medicine Autonomous University of Barcelona, Spain Tel: +34 93 497 86 62.
2
Chaim Sheba Medical Center Tel Hashomer, Israel and The Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel.
3
Cardiology Autonomous University of Barcelona and ICCC-St. Pau Hospital & Quiron University Hospital Barcelona, Spain.
4
University Cardiology Cardiovascular & Thoracic Department AOU Cittá della Salute e della Scienza di Torino and Department of Public Health and Pediatrics University of Torino, Torino, Italy.
PMID:
30052886
DOI:
10.1093/eurheartj/ehx246
[Indexed for MEDLINE]
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5.
Pediatr Cardiol. 2018 Dec;39(8):1535-1539. doi: 10.1007/s00246-018-1926-4. Epub 2018 Jun 14.

Does Prophylactic Ibuprofen After Surgical Atrial Septal Defect Repair Decrease the Rate of Post-Pericardiotomy Syndrome?

Author information

1
Division of Pediatric Cardiology, Cohen Children's Medical Center of New York, Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA. ERabinowitz@northwell.edu.
2
Division of Cardiothoracic Surgery, Cohen Children's Medical Center of New York, Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA.
3
Department of Pediatrics, Cohen Children's Medical Center of New York, Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA.
4
Department of Biostatistics, Feinstein Institute for Medical Research, Hofstra Northwell School of Medicine, 350 Community Dr, Manhasset, NY, 11030, USA.
5
Division of Pediatric Cardiology, Cohen Children's Medical Center of New York, Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA.
6
Division of Pediatric Critical Care Medicine, Cohen Children's Medical Center of New York, Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA.

Abstract

Post-pericardiotomy syndrome (PPS) is an inflammatory process involving the pleura, pericardium, or both and occurs after cardiothoracic surgery. Surgical atrial septal defect (ASD) closure is associated with higher incidence of PPS post-operatively as compared to other operations. Reported incidence of PPS varies from 1 to 40%. NSAIDs are often used to treat PPS and in our center, some practitioners have prescribed ibuprofen prophylactically. This study sought to investigate the impact of prophylactic treatment with ibuprofen on the development and severity of PPS following surgical ASD closure, with particular attention to secundum-type ASDs. We retrospectively reviewed clinical and operative data of all surgical ASD repairs in our center from 1/2007 to 7/2017. ASDs were grouped by subtype. PPS was considered positive if the primary cardiologist diagnosed and documented clinical signs of PPS on post-operative outpatient follow-up. Records were reviewed to confirm documented diagnosis of PPS. A total of 245 cases were reviewed with 207 having sufficient data. Median age was 2 years (range 4 months-27 years), female 57%. Overall incidence of PPS was 10%. There was no difference in incidence of PPS in those prescribed ibuprofen as compared to those who were not. This was true for both the entire cohort and the subgroup analysis (P = 1.0). Four patients overall required pericardiocentesis, none of whom received prophylactic ibuprofen. Prophylactic ibuprofen prescription following surgical ASD repair did not reduce the rate of PPS in our cohort.

KEYWORDS:

Atrial septal defect; Ibuprofen; Non-steroidal anti-inflammatory drugs; Post-cardiac injury syndrome; Post-pericardiotomy syndrome

PMID:
29948034
DOI:
10.1007/s00246-018-1926-4
[Indexed for MEDLINE]
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6.
Curr Cardiol Rep. 2018 Jun 14;20(8):62. doi: 10.1007/s11886-018-1008-5.

Colchicine in Pericardial Disease: from the Underlying Biology and Clinical Benefits to the Drug-Drug Interactions in Cardiovascular Medicine.

Author information

1
Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J3-129, Cleveland, OH, 44195, USA. schenoa@ccf.org.
2
Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J3-129, Cleveland, OH, 44195, USA.

Abstract

PURPOSE OF REVIEW:

This is an in-depth review on the mechanism of action, clinical utility, and drug-drug interactions of colchicine in the management of pericardial disease.

RECENT FINDINGS:

Recent evidence about therapeutic targets on pericarditis has demonstrated that NALP3 inflammasome blockade is the cornerstone in the clinical benefits of colchicine. Such benefits extend from acute and recurrent pericarditis to transient constriction and post-pericardiotomy syndrome. Despite the increased utilization of colchicine in cardiovascular medicine, safety concerns remains unsolved regarding the long-term use of colchicine in the cardiac patient. Moreover, recent evidence has demonstrated that numerous cardiovascular medications, ranging from antihypertensive medication to antiarrhythmics, are known to interact with the CYP3A4 and/or P-gp system increasing the toxicity potential of colchicine. The use of adjunctive colchicine in the management of inflammatory pericardial diseases is standard of care in current practice. It is advised that a careful medication reconciliation with emphasis on pharmacokinetic is completed before prescribing colchicine in order to avoid harmful interaction by finding an alternative regimen or adjusting colchicine dosing.

KEYWORDS:

Colchicine; Drug interactions; Pericardial disease; Toxicity

PMID:
29904810
DOI:
10.1007/s11886-018-1008-5
[Indexed for MEDLINE]
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7.
Expert Rev Cardiovasc Ther. 2018 Jun;16(6):405-412. doi: 10.1080/14779072.2018.1475231. Epub 2018 May 18.

Primary prevention of post-pericardiotomy syndrome using corticosteroids: a systematic review.

Author information

1
a Division of Cardiology, Kingston Health Science Center , Queen's University , Kingston , Canada.
2
b Division of Cardiovascular Surgery, Kingston Health Science Center , Queen's University , Kingston , Canada.
3
c Department of Medicine , Chinese University of Hong Kong , Hong Kong, SAR , P.R., China.
4
d Department of Cardiology , Tianjin Institute of Cardiology Second Hospital of Tianjin Medical University , Tianjin , China.

Abstract

Post-pericardiotomy syndrome is a well-recognized inflammatory phenomenon that commonly occurs in patients following cardiac surgery. Due to the increased morbidity and resource utilization associated with this condition, research has recently focused on ways of preventing its prevention this condition; primarily using colchicine, NSAIDs and corticosteroids. Areas covered: This systematic review summarizes the three clinical studies that have used corticosteroids for PPS primary prevention in the perioperative period. Due to the heterogeneity amongst these three studies in terms of population (both pediatric and adult patients), surgical procedure, administration regimen and results (only 1/3 studies reporting a positive effect), the effectiveness of corticosteroids remains unproven. Expert commentary: Corticosteroids have shown to be useful in the treatment of PPS but have thus far have shown mixed results as a primary prevention method. Research on patients taking corticosteroids pre-operatively have shown a significant reduction in the risk of developing PPS. Further research is required to determine if corticosteroids are helpful in preventing PPS in patient undergoing cardiac surgery, before any recommendations regarding their use in cardiovascular surgery can be made.

KEYWORDS:

Post-pericardiotomy syndrome; cardiac surgery; corticosteroids; dexamethasone; methylprednisolone; pericarditis; pleural effusion

PMID:
29745734
DOI:
10.1080/14779072.2018.1475231
[Indexed for MEDLINE]
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8.
BMJ Case Rep. 2018 May 8;2018. pii: bcr-2017-223618. doi: 10.1136/bcr-2017-223618.

Delayed recurrent pleuropericardial effusions following atrial septal defect closure with Amplatzer septal occluder device: a case of postpericardiotomy syndrome?

Author information

1
Department of Cardiology, Guy's and St Thomas' Hospital, London, UK.
2
Guy's and St Thomas' Hospital, London, UK.
3
Adult Congenital Heart Disease, Guy's and St Thomas' Hospital, London, UK.

Abstract

The authors present the case of a 41-year-old woman, who presented with moderate pericardial effusion and bilateral pleural effusion 11 months following a secundum atrial septal defect closure with an Amplatzer septal occluder (ASO) device. The acute presentation responded well to diuretics and a short course of corticosteroid therapy. The patient, however, continued to experience pleuritic chest pain and a recurrence of pericardial effusion a month later. The patient showed significant symptomatic improvement with a 2-month course of down-titrating prednisolone. Six months later, the echocardiogram showed complete remission of pleural and pericardial effusion. The possibility of cardiac erosion following ASO implantation has been excluded. The aetiology of the reoccurrence of steroid-responsive pleuropericarditis remains unknown.

KEYWORDS:

cardiovascular medicine; interventional cardiology

PMID:
29739762
DOI:
10.1136/bcr-2017-223618
[Indexed for MEDLINE]
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9.
Duodecim. 2017;133(4):411-6.

Postpericardiotomy syndrome.

Abstract

Postpericardiotomy syndrome (PPS) is a common complication following cardiac surgery. In most cases it develops 2 to 3 weeks after the operation. An inflammatory reaction develops in the pericardium or pleural space with fever, chest pain and dyspnea as typical symptoms. The disease process is usually self-limiting. At present, the etiology is unknown, but an immunological mechanism is suspected as the cause of the disease. The incidence of PPS is essentially dependent on diagnostic criteria, patient group and type of operation. Treatment is carried out with anti-inflammatory analgesics, combined with colchicine in more severe cases.

PMID:
29205989
[Indexed for MEDLINE]
10.
Isr Med Assoc J. 2017 Sep;19(9):562-565.

Carriage of Mediterranean Fever (MEFV) Mutations in Patients with Postpericardiotomy Syndrome (PPS).

Author information

1
Department of Internal Medicine F, Sheba Medical Center, Tel Hashomer, Israel.
2
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
3
Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Israel.
4
Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Israel.

Abstract

BACKGROUND:

Postpericardiotomy syndrome (PPS) is characterized by pleuro-pericardial inflammation, which occurs in patients undergoing surgical procedures involving the pleura, pericardium, or both. The syndrome is considered to be immune mediated. However, its pathogenesis is not fully understood. It has previously been demonstrated that the Mediterranean Fever (MEFV) gene, which is associated with familial Mediterranean fever (FMF), has a role in the activation and expression of several inflammatory diseases.

OBJECTIVES:

To investigate whether carriage of the MEFV mutation may precipitate PPS or affect its phenotype.

METHODS:

The study population included 45 patients who underwent cardiac surgery and developed PPS. The control group was comprised of 41 patients who did not develop PPS. Clinical and demographic data was collected. The severity of PPS was evaluated. Genetic analysis to determine the carriage of one the three most common MEFV gene mutations (M694V, V726A, E148Q) was performed. The carriage rate of MEFV mutations in patients with and without PPS was compared. Association between MEFV mutation carriage and severity of PPS was evaluated.

RESULTS:

The rate of mutation carriage in the MEFV gene was similar in patients with and without PPS (15.6% in the study groups vs. 29.3% in the control group, P = 0.1937). The rate of mutation carriage in the MEFV gene was significantly lower among patients with severe PPS as compared to patients with mild-moderate PPS (4.8% vs. 25%, P < 0.05).

CONCLUSIONS:

Carriage of mutations in the MEFV gene is not associated with development of PPS; however, it may affect PPS severity.

PMID:
28971640
[Indexed for MEDLINE]
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11.
Pediatr Emerg Care. 2017 Oct;33(10):700-702. doi: 10.1097/PEC.0000000000001271.

Point-of-Care Ultrasound to Diagnose Postpericardiotomy Syndrome in a Child.

Author information

1
From the *Division of Emergency Medicine, Boston Children's Hospital; and †Department of Pediatrics, Harvard Medical School, Boston, MA.

Abstract

We report a case of a patient presenting with abdominal pain after cardiac surgery who was noted on point-of-care ultrasound (POCUS) to have pericardial and pleural effusion, in addition to ascites. The most notable findings were pleural and pericardial effusions, which combined with symptomatology met criteria for postpericardiotomy syndrome. Point-of-care ultrasound expedited the diagnosis of a pericardial effusion with impending tamponade and transfer for pericardiocentesis and placement of pericardial drain.

PMID:
28968307
DOI:
10.1097/PEC.0000000000001271
[Indexed for MEDLINE]
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12.
Arch Argent Pediatr. 2017 Aug 1;115(4):e237-e242. doi: 10.5546/aap.2017.e237.

[Acute pericarditis, complicated by pericardial effusion in a pediatric patient: case report].

[Article in Spanish; Abstract available in Spanish from the publisher]

Author information

1
Hospital Infantil Miguel Servet, Zaragoza, Unidad de Cardiología Pediátrica, Unidad de Cuidados Intensivos Pediátricos. danielpalanca@hotmail.com.
2
Hospital Infantil Miguel Servet, Zaragoza, Unidad de Pediatría.
3
Hospital Infantil Miguel Servet, Zaragoza, Unidad de Cardiología Pediátrica.

Abstract

Acute pericarditis is the most common disease of the pericardium encountered in clinical practice. It is diagnosed in 0.1% of all admissions and 5% of emergency room admissions for chest pain. In developed countries, it is usually due to a benign cause. Idiopathic and infectious pericarditis are more common than secondary to surgical pericardiotomy or neoplastic causes, whereas tuberculosis is the dominant cause in developing countries. The most common symptoms of pericarditis are characteristic chest pain and fever. Since pericarditis presents a benign outcome because of self-limiting and good response to conventional anti-inflammatory therapy, it can be safely managed on outpatient basis unless a specific cause is suspected or the patient has high-risk features to avoid complications such as pericardial effusion, cardiac tamponade or recurrent pericarditis. We report a case of pericarditis, diagnosed 9 months after surgical closure of an atrial septal defect, in a 7-year-old boy with favorable evolution.

KEYWORDS:

acute pericarditis; chest pain; electrocardiography; pericardial effusion; postpericardiotomy syndrome

PMID:
28737876
DOI:
10.5546/aap.2017.e237
[Indexed for MEDLINE]
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13.
Adv Gerontol. 2017;30(2):269-275.

[Concentration of proinflammatory cytokines, peroxiredoxin-1 and glutathione peroxidase activity in the blood plasma of patients with coronary artery disease undergoing coronary artery bypass grafting].

[Article in Russian; Abstract available in Russian from the publisher]

Author information

1
Southern Federal University, Rostov-on-Don, 344006, Russian Federation; 89dmitry@mail.ru.
2
Rostov State Medical University, Rostov-on-Don, 344022, Russian Federation.

Abstract

76 patients with coronary heart disease (who had undergone coronary artery bypass grafting) were examined to investigate the role of pro-inflammatory cytokines and enzymes involved in redox regulation, in the mechanisms of development of systemic inflammatory response syndrome. Patients were divided into 2 groups: 1st - patients with coronary heart disease, who as a result of clinical trials has not been set postpericardiotomy syndrome; 2nd - patients with coronary heart disease who have been diagnosed postpericardiotomy syndrome. The blood plasma of both groups indicated intensification of production of interleukin-6, intrleukin-8, as well as - an imbalance in the peroxiredoxin-1 and glutathione peroxidase. These changes by patients with postpericardiotomy syndrome are observed at the earliest time and differed depth of expression. The results of this work confirm the high potential of the investigated indicators for prevention and monitoring postpericardiotomy syndrome development.

KEYWORDS:

coronary artery bypass; glutathione peroxidase; peroxiredoxin-1; postpericardiotomy syndrome; proinflammatory cytokines; systemic inflammatory response

PMID:
28575568
[Indexed for MEDLINE]
14.
Eur J Clin Invest. 2017 Jun;47(6):456-467. doi: 10.1111/eci.12764. Epub 2017 May 15.

Determinants of the postpericardiotomy syndrome: a systematic review.

Author information

1
Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
2
Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
3
Department of Anesthesiology and Intensive Care, University Medical Center Utrecht, Utrecht, the Netherlands.

Abstract

BACKGROUND:

Postpericardiotomy syndrome (PPS) is a common complication following cardiac surgery; however, the exact pathogenesis remains uncertain. Identifying risk factors of PPS might help to better understand the syndrome. The aim of this study was to provide an overview of existing literature around determinants of PPS in adult cardiac surgery patients.

MATERIAL AND METHODS:

Two independent investigators performed a systematic search in MEDLINE, EMBASE and the Cochrane Central Register. The search aimed to identify studies published between January 1950 and December 2015, in which determinants of PPS were reported.

RESULTS:

A total of 19 studies met the selection criteria. In these studies, 14 different definitions of PPS were used. The median incidence of PPS was 16%. After quality assessment, seven studies were considered eligible for this review. Lower preoperative interleukin-8 levels and higher postoperative complement conversion products were associated with a higher risk of PPS. Among other clinical factors, a lower age, transfusion of red blood cells and lower preoperative platelet and haemoglobin levels were associated with a higher risk of PPS. Colchicine use decreased the risk of PPS.

CONCLUSION:

We found that both the inflammatory response and perioperative bleeding and coagulation may play a role in the development of PPS, suggesting a multifactorial aetiology of the syndrome. Due to a lack of a uniform definition of PPS in the past, study comparability was poor across the studies.

KEYWORDS:

Bleeding; cardiac surgery; definition; inflammation; postpericardiotomy syndrome

PMID:
28425090
DOI:
10.1111/eci.12764
[Indexed for MEDLINE]
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15.
J Thorac Cardiovasc Surg. 2017 Apr;153(4):886-887. doi: 10.1016/j.jtcvs.2016.11.051. Epub 2016 Dec 12.

The significance of postpericardiotomy syndrome: A real threat or a simple nuisance?

Author information

1
Cardiovascular Intensive Care Unit, Cardiothoracic Anesthesiology and Critical Care Medicine, Swedish Heart and Vascular Institute, Physicians Anesthesia Services, Seattle, Wash. Electronic address: juan.pulido@swedish.org.
PMID:
28131509
DOI:
10.1016/j.jtcvs.2016.11.051
[Indexed for MEDLINE]
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16.
J Thorac Cardiovasc Surg. 2017 Apr;153(4):878-885.e1. doi: 10.1016/j.jtcvs.2016.10.075. Epub 2016 Nov 15.

Risk factors and prognosis of postpericardiotomy syndrome in patients undergoing valve surgery.

Author information

1
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: d.vanosch@umcutrecht.nl.
2
Department of Anesthesiology and Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands.
3
Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands.
4
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
5
Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.

Abstract

OBJECTIVE:

The study aim was to investigate the long-term prognosis and risk factors of postpericardiotomy syndrome (PPS).

METHODS:

We performed a single-center cohort study in 822 patients undergoing nonemergent valve surgery. Risk factors of PPS were evaluated using multivariable logistic regression analysis. We also compared the incidence of reoperation for tamponade at 1 year between patients with and without PPS. Main secondary outcomes were hospital stay and mortality.

RESULTS:

Of the 822 patients, 119 (14.5%) developed PPS. A higher body mass index (odds ratio (OR) per point increase, 0.94; 95% confidence interval (CI), 0.89-0.99) was associated with a lower risk of PPS, whereas preoperative treatment for pulmonary disease without corticosteroids (OR, 2.55; 95% CI, 1.25-5.20) was associated with a higher risk of PPS. The incidence of reoperation for tamponade at 1 year in PPS versus no PPS was 20.9% versus 2.5% (OR, 15.49; 95% CI, 7.14-33.58). One-year mortality in PPS versus no PPS was 4.2% versus 5.5% (OR, 0.68; 95% CI, 0.22-2.08). Median hospital stay was 13 days (interquartile range, 9-18 days) versus 11 days (interquartile range, 8-15 days) (P = .001), respectively.

CONCLUSIONS:

Despite longer hospital stays and more short-term reoperations for tamponade, patients with PPS had an excellent 1-year prognosis.

KEYWORDS:

postpericardiotomy syndrome; prognosis; reintervention; risk factors; tamponade

PMID:
27919456
DOI:
10.1016/j.jtcvs.2016.10.075
[Indexed for MEDLINE]
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17.
Curr Cardiol Rep. 2016 Nov;18(11):116.

Post-pericardiotomy Syndrome.

Author information

1
Center for the Diagnosis and Treatment of Pericardial Disease, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J1-5, Cleveland, OH, 44195, USA. balaji.tamarappoo@cshs.org.
2
Center for the Diagnosis and Treatment of Pericardial Disease, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J1-5, Cleveland, OH, 44195, USA.

Abstract

Post-pericardiotomy syndrome (PPS) occurs in a subgroup of patients who have undergone cardiothoracic surgery and is characterized by fever, pleuritic pain, pleural effusion, and pericardial effusion. It is associated with significant morbidity, and the leading complications include tamponade and constrictive pericarditis. Epidemiologic studies have found that PPS often occurs among younger patients; however, there is a lack of comprehensive risk stratification. It is therefore important to be able to identify patients who are at high risk for developing this disease. The diagnosis is made if patients present with 2 out of the following 5 criteria; fever, pericardial or pleuritic chest pain, pericardial or pleural friction rub, pericardial effusion, and pleural effusion with elevated C-reactive protein (CRP). Pericardial effusion associated with PPS is detected by echocardiography, and cardiac MRI is used for evaluation of pericardial thickening as well as inflammation associated with PPS. These imaging modalities have been invaluable for monitoring the efficacy of treatment in PPS. Aspirin, nonsteroidal anti-inflammatory agents (NSAID), and colchicine are the mainstay of the current treatment for PPS. Although steroids are used for refractory cases of PPS, they are associated with significant side effects when used for long-term treatment of this disease. It is important for future research to focus on identification of clinical, serologic, and genetic markers that may predispose patients to PPS. There is also a need for clinical trials to address the use of targeted immunomodulatory treatment for this disease.

KEYWORDS:

Cardiac MRI; Colchicine; Echocardiography; NSAID; Pericardial effusion; Pericardial injury

PMID:
27761786
DOI:
10.1007/s11886-016-0791-0
[Indexed for MEDLINE]
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18.
Arch Dis Child. 2016 Oct;101(10):953-6. doi: 10.1136/archdischild-2015-310287. Epub 2016 Apr 15.

Colchicine for children with pericarditis: systematic review of clinical studies.

Author information

1
Academic Radiology Registrar at Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
2
Cochrane México, Hospital Pediátrico de Sinaloa, Culiacán, México.
3
Professor of Public Health, City University London, London, UK.

Abstract

OBJECTIVE:

To review the evidence for the efficacy and safety of colchicine in children with pericarditis.

DESIGN:

Systematic review.

SEARCH STRATEGY:

The following databases were searched for studies about colchicine in children with pericarditis (June 2015): Cochrane Central, Medline, EMBASE and LILACS.

ELIGIBILITY CRITERIA:

All observational and experimental studies on humans with any length of follow-up and no limitations on language or publication status were included. The outcomes studied were recurrences of pericarditis and adverse events.

DATA EXTRACTION:

Two authors extracted data and assessed quality of included studies using the Cochrane risk of bias tool for non-randomised trials.

RESULTS:

Two case series and nine case reports reported the use of colchicine in a total of 86 children with pericarditis. Five articles including 74 paediatric patients were in favour of colchicine in preventing further pericarditis recurrences. Six studies including 12 patients showed that colchicine did not prevent recurrences of pericarditis.

LIMITATIONS:

No randomised controlled trials (RCTs) were found.

CONCLUSIONS:

Although colchicine is an established treatment for pericarditis in adults, it is not routinely used in children. There is not enough evidence to support or discourage the use of colchicine in children with pericarditis. Further research in the form of large double-blind RCTs is needed to establish the efficacy of colchicine in children with pericarditis.

KEYWORDS:

colchicine; pericarditis; systematic review

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19.
Eur Rev Med Pharmacol Sci. 2016 Mar;20(5):906-11.

Value of the neutrophil-to-lymphocyte ratio in predicting post-pericardiotomy syndrome after cardiac surgery.

Author information

1
Department of Cardiovascular Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey. utkansevuk@gmail.com.

Abstract

OBJECTIVE:

Post-pericardiotomy syndrome (PPS) occurs in 10-40% of patients after cardiac surgery. PPS is considered an autoimmune phenomenon. The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory marker that is associated with various cardiovascular diseases. Studies have reported that the NLR increases in certain autoimmune diseases. This study examined whether the NLR is helpful to predict the occurrence of PPS after elective on-pump coronary artery bypass graft (CABG) surgery.

PATIENTS AND METHODS:

The records of patients who underwent elective first-time on-pump CABG were reviewed retrospectively. In total, 72 patients with PPS were included in the study, and 100 patients who did not develop PPS were included as the control group. Peripheral blood samples collected preoperatively and on postoperative day 1 were used to calculate the NLR.

RESULTS:

No differences in preoperative white blood cell (WBC) count, neutrophil count, lymphocyte count, or NLR were observed between the patients with PPS and the control group. The WBC (p < 0.001) and neutrophil counts (p < 0.001) and NLR (p = 0.01) were significantly higher during the postoperative period in patients with PPS than in the control group. A receiver operating characteristic curve analysis showed that the postoperative NLR predicted PPS with 60% sensitivity and 59% specificity (area under the curve, 0.61; 95% confidence interval [CI], 0.51-0.70; p = 0.017), using a cut-off of 8.34. The postoperative WBC count (odds ratio [OR], 1.6; 95% CI, 1.36-2.03; p < 0.001) and NLR (OR, 3.3; 95% CI, 1.56-7.01; p = 0.002) were independently associated with PPS.

CONCLUSIONS:

The postoperative NLR may be useful to predict the development of PPS in patients undergoing on-pump CABG.

PMID:
27010149
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20.
Eur Rev Med Pharmacol Sci. 2016;20(3):514-9.

Role of methylprednisolone in the prevention of postpericardiotomy syndrome after cardiac surgery.

Author information

1
Department of Cardiovascular Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey. utkansevuk@gmail.com.

Abstract

OBJECTIVE:

Postpericardiotomy syndrome (PPS) occurs in 10-40% of patients after cardiac operations. Pericardial effusions and tamponade occurring > 7 days after surgery are usually related to PPS and remain an important cause of cardiac surgery-related morbidity and mortality; therefore, preventing PPS is important. Colchicine affords safe and efficacious protection against PPS and related complications. However, the roles of corticosteroids and nonsteroidal anti-inflammatory drugs in PPS prevention remains unclear. This study aimed to determine whether the intraoperative use of single-dose methylprednisolone can effectively prevent PPS.

PATIENTS AND METHODS:

This retrospective study included 100 patients undergoing elective coronary artery bypass grafting (CABG) who received a single intraoperative dose of 1 mg/kg methylprednisolone. A further 100 patients undergoing CABG, who were not given methylprednisolone, comprised the control group. The presence and severity of pericardial effusion was determined by echocardiography, with chest X-ray used to assess pleural effusion.

RESULTS:

PPS occurrence and pericardial effusion occurrence were significantly lower in patients who received methylprednisolone (p = 0.02 and p = 0.007 respectively). Although the differences were not statistically significant, pericardial and pleural effusions were more severe in the control group than in the methylprednisolone group. Logistic regression analysis demonstrated that methylprednisolone administration was independently associated with prevention of PPS (OR 0.8, 95% CI 0.25-0.91, p <  0.026).

CONCLUSIONS:

Intraoperative, single-dose methylprednisolone may confer protection against PPS in patients undergoing CABG.

PMID:
26914128
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