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

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 153; no. 4; pp. 878 - 885.e1
• Main Authors: van Osch, Dirk, Dieleman, Jan M., Bunge, Jeroen J., van Dijk, Diederik, Doevendans, Pieter A., Suyker, Willem J., Nathoe, Hendrik M., Bredée, Jaap J., Buhre, Wolfgang F., van Herwerden, Lex A., Kalkman, Cor J., van Klarenbosch, Jan, Moons, Karel G., Numan, Sandra C., Ottens, Thomas H., Roes, Kit C., Sauer, Anne-Mette C., Slooter, Arjen J., Jacob, Kirolos A., Nierich, Arno P., Ennema, Jacob J., Rosseel, Peter M., van der Meer, Nardo J., van der Maaten, Joost M., Cernak, Vlado, Hofland, Jan, van Thiel, Robert J., Diephuis, Jan C., Schepp, Ronald M., Haenen, Jo, de Lange, Fellery, Boer, Christa, de Jong, Jan R., Tijssen, Jan G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2017
• Subjects: Aged; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - mortality; Cardiac Tamponade - etiology; Cardiac Tamponade - mortality; Cardiac Tamponade - surgery; Cardiothoracic Surgery; Female; Heart Valve Diseases - mortality; Heart Valve Diseases - surgery; Heart Valves - surgery; Humans; Length of Stay; Male; Middle Aged; postpericardiotomy syndrome; Postpericardiotomy Syndrome - etiology; Postpericardiotomy Syndrome - mortality; Postpericardiotomy Syndrome - surgery; prognosis; Randomized Controlled Trials as Topic; reintervention; Reoperation; Retrospective Studies; Risk Assessment; Risk Factors; tamponade; Time Factors; Treatment Outcome; LMWH; risk factors; PPS; IL; AF; postpericardiotomy syndrome; tamponade; reintervention; CABG; prognosis; DECS; BMI; body mass index; low molecular weight heparin; atrial fibrillation; Dexamethasone for Cardiac Surgery trial; interleukin; coronary artery bypass grafting
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2016.10.075

The study aim was to investigate the long-term prognosis and risk factors of postpericardiotomy syndrome (PPS). 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. 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. Despite longer hospital stays and more short-term reoperations for tamponade, patients with PPS had an excellent 1-year prognosis.