A1 Refereed original research article in a scientific journal
Adverse events and survival with postpericardiotomy syndrome after surgical aortic valve replacement
Authors: Joonas Lehto, Jarmo Gunn, Rikhard Björn, Markus Malmberg, K.E. Juhani Airaksinen, Ville Kytö, Tuomo Nieminen, Juha E.K. Hartikainen, Fausto Biancari, Tuomas O. Kiviniemi
Publisher: Elsevier
Publication year: 2020
Journal: Journal of Thoracic and Cardiovascular Surgery
Journal name in source: The Journal of thoracic and cardiovascular surgery
Journal acronym: J Thorac Cardiovasc Surg
Volume: 160
Issue: 10
First page : 1446
Last page: 1456
ISSN: 0022-5223
eISSN: 1097-685X
DOI: https://doi.org/10.1016/j.jtcvs.2019.12.114
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/46774822
ObjectivesPostpericardiotomy syndrome (PPS) is a relatively common complication after cardiac surgery. However, long-term follow-up data on the adverse events and mortality of PPS patients requiring invasive interventions are scarce.MethodsWe sought to assess the occurrence of mortality, new-onset atrial fibrillation (AF), cerebrovascular events, and major bleeds in PPS patients requiring medical attention in a combination database of 671 patients who underwent isolated surgical aortic valve replacement with a bioprosthesis (n = 361) or mechanical prosthesis (n = 310) between 2002 and 2014 (Cardiovascular Research Consortium—A Prospective Project to Identify Biomarkers of Morbidity and Mortality in Cardiovascular Interventional Patients [CAREBANK] 2016-2018). PPS was defined as moderate if it resulted in delayed hospital discharge, readmission, or medical therapy because of the symptoms; and severe if it required interventions for the evacuation of pleural or pericardial effusion.ResultsThe overall incidence of PPS was 11.2%. Median time to diagnosis was 16 (interquartile range, 11-36) days. Severe PPS was diagnosed in 3.6% of patients. Severe PPS seemed to be associated with higher mortality (hazard ratio, 2.01; 95% confidence interval, 1.03-3.91; P = .040). Moderate or severe PPS increased the risk of new-onset AF during the early postoperative period (hazard ratio, 1.72; 95% confidence interval, 1.12-2.63; P = .012). No significant associations were found between PPS and cerebrovascular events or major bleeds during the follow-up.ConclusionsPatients with PPS requiring invasive interventions are at increased risk for mortality unlike those with mild to moderate forms of the disease. PPS requiring medical attention is associated with a higher AF rate during the early postoperative period but has no significant effect on the occurrence of major stroke, stroke or transient ischemic attack, or major bleeds during long-term follow-up.
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