Preventie van het ‘post-cardiac injury syndrome’ bij cardiale heelkunde

Abstract

Prevention of post-cardiac injury syndrome after cardiac surgery The post-cardiac injury syndrome (PCIS) is a major cause of pericarditis after cardiac surgery, myocardial infarction or chest trauma. PCIS is an immune-mediated inflammatory process as a result of cardiac tissue damage with antigen exposure. The clinical presentation is variable, but systemic inflammation is required for the diagnosis. PCIS is associated with prolonged hospitalization, invasive interventions and a higher mortality rate, especially in case of invasive cardiac surgery, which supports the use of prophylaxis. Research with methylprednisolone, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) shows no protective effect. However, prophylactic administration of colchicine prevents the development of PCIS, at the expense of some adverse effects. Low-dose postoperative administration of colchicine during 1 month should be considered after cardiac surgery to prevent PCIS (guidelines IIA of the European Society of Cardiology (ESC)). Therapeutic cardiac lymphangiogenesis, in which a higher clearance of inflammatory cells is obtained, is a potential future method for the prevention of PCIS, but this needs more study.