The Incidence and Clinical Outcome of Cardiac Tamponade Following an Open Heart Surgery in a Developing Country

Abstract

Introduction: Pericardial effusion is not uncommon following an open heart surgery, thus, it may progress to cardiac tamponade. This is a retrospective cross-sectional analysis evaluates the incidence, the potential perioperative and surgical risk factors causing cardiac tamponade following an open-heart surgery of patients during the period 2001-2006 at Ahmed Gasim Cardiac Center in Khartoum, North Sudan.
 Methods: Diagnosis of cardiac tamponade was based on clinical and echocardiographic findings. Univariate analysis was performed to assess possible risk factors related to both, early and late cardiac tamponade.
 Results: Among the 890 patients who underwent open heart surgery in this study, 47(5%) patients developed tamponade (early 49% or 51%). Early cardiac tamponade was found to be present with significant cardiac compromise and can easily be detected using echocardiography. In contrast the presentation of late cardiac tamponade, atypical and echocardiography was inconclusive. The mean age of patients was 31 ± 12 with slight female predominance. The main indication for the operation was rheumatic heart disease (89%), mainly mechanical valve replacement of the mitral valve. Eight (17%) patients were receiving warfarin preoperatively. Oozing wounds and blocked drains were encountered in 27% and 37%, respectively. About 6% of the patients recollect tamponade after decompression and one in-hospital death directly related to the cardiac tamponade.
 Conclusion: Significant cardiac tamponade was associated with preexisting rheumatic heart disease, (preoperative warfarin use), mechanical valve replacement in the mitral position, oozing wounds and blocked drain. Echocardiography was reliable in early diagnosis, but not late, hemodynamically significant cardiac tamponade.