Relationship between history of previous surgeries and pericardial involvement in patients undergoing cardiac surgery

Abstract

Objective: We aimed to define whether timing and multiple surgeries have an impact on development of postpericardiotomy syndrome (PPS) and its complications. Methods: We retrospectively analyzed clinical and operative data of 40 patients with signs of PPS after cardiac surgery. Among them, 9 patients had signs of effusion (E) only and 31 patients had adhesive/ constrictive/constrictive-effusive (C) pericardial involvement. Results: Patients in E only group had significantly larger E size (p=0.03), higher white blood cell count (p=0.014) and tendency to higher sedimentation rate (SR) as compared to C group. We found significantly longer period of hospital stay (p=0.042), higher number of redo surgeries (1.33(0.88) vs 0.67(0.50), p=0.008) and longer time past since latest surgery (102.91(97.49) vs. 0.14(0.38) months, p<0.0001) in patients with C as compared to patients with E. Correlation analysis demonstrated positive correlation between E amount and SR (r=0.66, p0.008), and its negative correlation with number of reoperations (r=-0.83, p=-0.0001)  and time related to operation  (r=-0.69, p=0.001); while thickening of pericardium was related positively with C-reactive protein (r=0.59, p=0.026), and time related to operation (r=0.51, p=0.004). In our small preliminary selected series of patients undergoing cardiac surgery, PPS was complicated by signs of tamponade in 2.5%  of patients and constriction in 7.5%. Conclusion: Thus, postpericardiotomy effusions are associated with the shorter time from surgery and less number of redo-surgeries, and inflammation, while adhesive pericardial involvement more often develops in patients with longer period after surgery and thickening of pericardium is positively associated with increase of C-reactive protein levels and time related to operation. Key words: pericardial effusion, constriction, cardiac surgery procedures