342 - Predictors and Characteristics of Pericardial Effusions Post OHT

Abstract

Introduction: The predictors and features of pericardial effusions post OHT are unclear. Prior investigations have identified size mismatch between donor and recipient, rejection, and prior sternotomy as factors that predict the development of pericardial effusions. Hypothesis: The aim of this study was to assess risk factors for the development of post OHT pericardial effusions, describe their etiology, location and methods of treatment or follow up. Methods: The records and echocardiograms of all patients receiving heart transplants at a large academic medical center between 4/2007-4/2015 were reviewed for the presence of pericardial effusion in the first year post OHT. Effusions were characterized by size (small, moderate, large), location (anterior, posterior, circumferential) and need for intervention. Baseline characteristics were investigated as potential predictors of effusion development via logistic regression. Results: Of the 214 patients receiving heart transplants, 77 (36%) had effusions within the first year. The only predictor for the development of pericardial effusion was absence of prior sternotomy (50% vs 33% P = .02) (Table 1). Most of the effusions were anterior (40%) or circumferential (47%). There was no association between size of effusion and location. A total of 9 patients (12%) required intervention at a mean of 15 ± 4 days from OHT (6 surgical, 3 percutaneous). Tamponade or early tamponade was seen in 5 of these patients. Post-surgical hemopericardium was suspected in 6 of these patients, while perforation from right heart biopsy was the etiology of effusion in a single patient. A majority of effusions (8/9) that required intervention were circumferential (P = .04). 21 patients continued to have an effusion for at least 1 year post transplant without hemodynamic consequence. 11 patients developed a late effusion (>1 month post OHT) effusion, also without apparent hemodynamic consequence. Conclusions: Absence of prior sternotomy was the only characteristic associated with a higher rate of effusion. Size mismatch did not predict the development of an effusion in our cohort. Most effusions were anterior or circumferential. Approximately 12% of effusions required intervention and none required intervention after the first month of transplant. Effusions requiring intervention were more likely to be circumferential.Table 1