Adverse events and survival with postpericardiotomy syndrome after surgical aortic valve replacement.

Abstract

OBJECTIVES:

Postpericardiotomy 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.

METHODS:

We 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.

RESULTS:

The 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.

CONCLUSIONS:

Patients 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.

• 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
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 160 Issue 6 Pg. 1446-1456 (Dec 2020) ISSN: 1097-685X [Electronic] United States
• PMID: 32107032 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Aortic Valve (diagnostic imaging, surgery)
• Cardiac Surgical Procedures (adverse effects)
• Female
• Finland (epidemiology)
• Follow-Up Studies
• Forecasting
• Heart Valve Diseases (surgery)
• Humans
• Incidence
• Male
• Middle Aged
• Postoperative Complications
• Postpericardiotomy Syndrome (diagnosis, epidemiology)
• Prospective Studies
• Risk Factors
• Survival Rate (trends)