Preventie van het postpericardiotomiesyndroom na cardiale heelkunde: wie heeft baat bij profylaxe?

Abstract

Who should need colchicine for prevention of the postpericardiotomy syndrome? The post-cardiac pericardiotomy syndrome (PPS) is a probably immune-mediated inflammatory process as a reaction on cardiac tissue damage. It is a major cause of pericarditis after cardiac surgery, myocardial infarction or chest trauma, as well as less invasive surgery such as ablations or pacemaker lead insertions. It occurs in up to 29% of all patients following cardiac surgery. PPS is associated with a prolonged hospitalization, readmissions, the need for invasive interventions and a higher mortality rate, especially in case of invasive cardiac surgery. Colchicine prevents PPS at the cost of adverse events. Identification of patients prone to PPS is important to make an adequate prophylactic administration of colchicine possible. The aim of the study was to evaluate the risk factors for developing PPS after cardiac surgery. By reviewing the literature, multiple possible risk factors were identified: patient-related factors, environment-related factors, peri- and postoperative biochemical determinants, and procedure-related factors. A prospective indexation of all these risk factors as well as awareness for PPS can help the clinician to better identify these high-risk groups and optimally use prophylactic colchicine therapy for PPS prevention.