321 Predictive factors for late cardiac tamponade after cardiac surgery

Abstract

Cardiac tamponade (CT) occurs in about 1% to 2% of patients after cardiac surgery. In order to know which patients should be closely followed up, it is important to determine predictive factors for late CT. in the POPE study, 196 patients with a moderate to large persistent pericardial effusion persisting more than 7 days after cardiac surgery (grades 2, 3, or 4 on a scale of 0 to 4, as measured by echocardiography) were consecutively included. The main result showed the absence of effectiveness of a non steroidal anti inflammatory drug to reduce the size of the effusions. As Twenty patients (10.2%) required pericardial drainage 22.5 ± 8.7 days after surgery, we looked for predictive factors for late CTs by comparing baseline characteristics of the CT (n = 20) and non CT groups (n = 176). The incidence of late CTs was higher with higher grades of pericardial effusion at baseline: 2.9% for grade 2, 14% for grade 3, and 24.3% for grade 4 ( P < 0.001). vitamin K antagonist (VKA) administration was not correlated with the risk of CT (42.9% of the patients in the non CT group versus 45.0% in the CT one, p = 0.8) but a high INR at baseline was correlated with development of a late CT: mean baseline INR and percentage of patients with a baseline INR>2.5 were of 2.56 ± 1.0 and 47.8%in the non CT group versus 3.25 ± 1.03 and 88.9% in the late CT group (p = 0.05 and 0.02 respectively). Finally, the rate of diabetic patients was significantly lower in the non CT group (16.6% vs 35%; p = 0.04). Age, gender, body mass index, history of high blood pressure, left ventricular ejection fraction, type of surgery (valvular surgery or coronary artey bypass graft, mean internal thoracic artery implants), baseline C reactive protein rate, antiplatelet therapy, non steroidal anti inflammatory drug administration, creatininemia, haemoglobinemia, atrial fibrillation and localisation of the pericardial effusion were not correlated with the development of a late CT. Baseline pericardial effusion grade, oral anticoagulant and diabetes are correlated with the risk of development of a late cardiac tamponade after cardiac surgery.