Controversies in the prophylaxis and treatment of postsurgical pericardial syndromes: a critical review with a special emphasis on paediatric age.

Abstract

Postsurgical pericardial syndromes are common complications after cardiac surgery; however, their treatment is not well established yet. We reviewed the accuracy and limits of clinical trials of prophylaxis and treatment of these diseases to identify an evidence-based therapeutic approach. We performed a literature search in the National Library of Medicine using the keywords pericardial effusion, cardiac surgery and paediatric/congenital. The research was then redefined adding separately the keywords postpericardiotomy syndrome, NSAIDs, steroids and colchicine. We found 12 clinical trials (eight for the prophylaxis and four regarding treatment), testing three major agent classes: NSAIDs, corticosteroids and colchicine. Therapy is generally based on NSAID with or without steroids with the adjunct of colchicine for recurrences. Only a few randomized controlled trials (RCTs) in adults support NSAID therapy. Efficacy of steroids has been proved only in small paediatric works, whereas no studies are available for colchicine. Studies furthermore presented some limitations: not univocal endpoints (not allowing for a meta-analysis), a limited sample size, scarce attention to confounders (such as the underlying cardiac disease and diuretic/analgesic regimen). Moreover, different agents were not assessed, nor when to start therapy. More evidence (two wide RCT plus a meta-analysis) supports the role of colchicine for prophylaxis in adults. Prophylaxis with NSAID/corticosteroids instead failed to have significant advantage in children, whereas a few data are available for adults. Evidence for the treatment of postsurgical pericardial syndromes is incomplete, making it difficult to understand when to treat and which agent to employ, especially in children.

• Authors: Massimiliano Cantinotti, Isabella Spadoni, Nadia Assanta, Maura Crocetti, Marco Marotta, Luigi Arcieri, Bruno Murzi, Massimo Imazio
• Journal: Journal of cardiovascular medicine (Hagerstown, Md.) (J Cardiovasc Med (Hagerstown)) Vol. 15 Issue 12 Pg. 847-54 (Dec 2014) ISSN: 1558-2035 [Electronic] United States
• PMID: 23846676 (Publication Type: Journal Article, Review)

Chemical References

• Adrenal Cortex Hormones
• Anti-Inflammatory Agents, Non-Steroidal
• Colchicine

Topics

• Adolescent
• Adrenal Cortex Hormones (adverse effects, therapeutic use)
• Age Factors
• Anti-Inflammatory Agents, Non-Steroidal (adverse effects, therapeutic use)
• Cardiac Surgical Procedures (adverse effects)
• Child
• Child, Preschool
• Colchicine (adverse effects, therapeutic use)
• Humans
• Infant
• Infant, Newborn
• Pericardial Effusion (etiology, prevention & control, therapy)
• Pericardiectomy (adverse effects)
• Risk Factors
• Syndrome
• Treatment Outcome
• Young Adult