Postpericardiotomy Syndrome Research Articles

Ten questions about constrictive pericarditis

Constrictive pericarditis is one of the most feared complications of patients with pericarditis, especially if recurrent. The common perception is that the higher the number of recurrences, the higher the risk of constriction. However, the risk of constriction is related to the etiology and not to the number of recurrences. Constriction has never been reported as a complication of idiopathic recurrent pericarditis, while the risk is low (<1%) after a first attack of idiopathic or viral pericarditis, intermediate for immune-mediated etiologies (2-5%, e.g. systemic inflammatory diseases, post-pericardiotomy syndromes) and cancer, and high especially for bacterial etiologies (20.30%, e.g. tuberculosis, purulent pericarditis). Constriction may be reversible in the setting of pericarditis and about 7-10% of patients with acute pericarditis may have transient constriction during the acute phase of inflammation, due to increased pericardial stiffness. Empiric anti-inflammatory therapy may prevent pericardiectomy in one half of cases.The clinical diagnosis is not easy but feasible with prompt recognition of the clinical symptoms and signs that may mimic heart failure and chronic hepatic disease (e.g. jugular vein distention, peripheral edema, ascites), the echocardiographic signs (e.g. septal bounce, respiratory variations of transmitral and tricuspid flows, annulus reversus, inferior vena cava plethora), and other imaging features (e.g. pericardial thickening in about 80% of cases, pericardial calcifications).In this paper, we will try to give an answer to common clinical doubts for assessing the risk of constriction, making the diagnosis, and addressing the therapy of these patients also underlying the possible outcomes.

Acute post cardiac injury syndrome occurring immediately after a demanding percutaneous coronary intervention.

Postcardiac injury syndrome (PCIS) occurs as a complication of myocardial infarction (Dressler's syndrome), of cardiac surgery (post-pericardiotomy syndrome), or post-traumatic (either iatrogenic or non-iatrogenic) and involves a pericardial or myocardial injury. There is scarce data regarding occurrence and pathogenesis of PCIS after invasive procedures. Herein, we describe a unique case of acute PCIS with typical clinical, laboratory, echocardiographic findings that occurred one hour after a demanding multi-stenting percutaneous coronary intervention. Possible pathogenetic mechanisms and treatment options are being discussed.

P6298Meta-analysis for the value of colchicine for the therapy and prevention of recurrence of pericarditis, and for rehospitalization for pericarditis and postpericardiotomy syndrome

P6298Meta-analysis for the value of colchicine for the therapy and prevention of recurrence of pericarditis, and for rehospitalization for pericarditis and postpericardiotomy syndrome

Content of proinflammatory cytokines, peroxiredoxin-1, and activity of glutathione peroxidase in blood plasma of coronary artery disease patients after coronary artery bypass grafting

An examination of a group of 76 CAD patients after coronary artery bypass grafting was performed with the goal to investigate the role of proinflammatory cytokines and enzymes participating in redox regulation in the mechanisms of development of systemic inflammation response and pathogenesis of postpericardiotomy syndrome (PPS). The patients were divided into two groups: the first group was CAD patients that were not diagnosed with PPS based on clinical examination, and the second group was CAD patients diagnosed with PPS. The enhancements of IL-6 and IL-8 production, as well as imbalance in the functions of peroxiredoxin-1 and glutathione peroxidase, was observed in the blood plasma of the patients from both groups. These changes were observed at earlier stages in the patients with PPS, and they were more substantial. The results of this work confirmed the high efficiency of the investigated indicators for prevention and monitoring of the PPS development.

Determinants of the postpericardiotomy syndrome: a systematic review.

Postpericardiotomy syndrome (PPS) is a common complication following cardiac surgery; however, the exact pathogenesis remains uncertain. Identifying risk factors of PPS might help to better understand the syndrome. The aim of this study was to provide an overview of existing literature around determinants of PPS in adult cardiac surgery patients. Two independent investigators performed a systematic search in MEDLINE, EMBASE and the Cochrane Central Register. The search aimed to identify studies published between January 1950 and December 2015, in which determinants of PPS were reported. A total of 19 studies met the selection criteria. In these studies, 14 different definitions of PPS were used. The median incidence of PPS was 16%. After quality assessment, seven studies were considered eligible for this review. Lower preoperative interleukin-8 levels and higher postoperative complement conversion products were associated with a higher risk of PPS. Among other clinical factors, a lower age, transfusion of red blood cells and lower preoperative platelet and haemoglobin levels were associated with a higher risk of PPS. Colchicine use decreased the risk of PPS. We found that both the inflammatory response and perioperative bleeding and coagulation may play a role in the development of PPS, suggesting a multifactorial aetiology of the syndrome. Due to a lack of a uniform definition of PPS in the past, study comparability was poor across the studies.

PP20 - Pericardial disease after cardiac surgery: postpericardiotomy syndrome, purulent and constrictive pericarditis

PP20 - Pericardial disease after cardiac surgery: postpericardiotomy syndrome, purulent and constrictive pericarditis

Postpericardiotomy syndrome and its complications: prevalence, clinical significance and management

In this review, we summarized current evidence on clinical significance, outcomes and management of postpericardiotomy syndrome and its complications developing after cardiac operations.

Venoarterial extracorporeal membrane oxygenation for cardiogenic shock: a retrospective analysis based on the etiology of shock

Background&#x0D; We performed a retrospective analysis to evaluate the efficacy of VA-ECMO support in cardiogenic shock based on various etiologies.&#x0D; Methods&#x0D; We retrospectively analyzed 99 patients supported with VA-ECMO from January 1, 2012 to January 1, 2015. Outcomes included survival to discontinuation of VA-ECMO support and survival to hospital discharge. The etiologies of cardiogenic shock included cardiac arrest (CPR), acute myocardial infarction (AMI), decompensated congestive heart failure (CHF), pulmonary embolism (PE), right ventricular failure (RVF) not secondary to an acute pulmonary embolism, and post-cardiotomy syndrome (PCS). The PCS group was used as a reference group; odds ratios were estimated and Fisher’s exact tests were performed to compare each other group to the reference.&#x0D; Results&#x0D; Patients supported with VA-ECMO due to PE and CHF had better survival to hospital discharge (83.3% and 54.2%, with p = 0.003 and p = 0.011, respectively) versus the PCS group (7.7%). The PE, CHF, and AMI groups had statistically improved survival to VA-ECMO discontinuation. There was no statistically significant difference in survival to VA-ECMO discontinuation or hospital discharge in four subgroup analyses.&#x0D; Conclusions&#x0D; Patients supported with VA-ECMO in cardiogenic shock due to PE or CHF demonstrated increased rates of survival to hospital discharge when compared to the PCS group. This study also highlights the need for a more uniform system of categorizing etiologies of cardiogenic shock.

What's Old is New Again - A Review of the Current Evidence of Colchicine in Cardiovascular Medicine.

Colchicine is a well-established drug approved by the Food and Drug Administration (FDA) for the prevention and treatment of gout. It possesses unique anti-inflammatory properties. Interests in the usage of colchicine in cardiovascular medicine have been rekindled recently with several large trials been carried out to investigate its efficacy in treatment of various cardiac conditions including pericarditis, postpericardiotomy syndrome, atrial fibrillation and coronary artery disease. In this review, the basic pharmacological properties of colchicine will be discussed, and the evidences of its benefits for different applications in cardiovascular medicine will be reviewed.

Financial and clinical outcomes of extracorporeal mechanical support.

Over the past decade, extracorporeal mechanical support (ECMO) has been increasingly utilized in respiratory failure and cardiogenic shock. There is a need for assessing clinical and financial outcomes of ECMO use. This study presents our institution's experience with veno-arterial ECMO (VA-ECMO) over a 9-year period. A retrospective review of our institution's ECMO database identified patients undergoing VA-ECMO between 2005 and 2013 (N = 150). Patients were assigned to four groups by indication: post-cardiotomy syndrome, cardiogenic shock requiring cardiopulmonary resuscitation (CPR), cardiogenic shock not requiring CPR, and respiratory failure. Hospital charges from administrative records were analyzed. Trend and correlation analyses were used to evaluate clinical and financial outcomes. Of the 150 patients meeting inclusion criteria, 28% required VA-ECMO for post-cardiotomy syndrome, 31.3% for cardiogenic shock with CPR, 35.3% for cadiogenic shock with no CPR, and 5.4% for respiratory failure. Mean duration on ECMO was 5.0 ± 3.4 days with a survival rate of 64% and no difference between the four groups (p = 0.40). ECMO-associated charges averaged $74,500 ± 61,400 per patient, 6% of total hospital charges. Subgroup analysis of cardiogenic shock patients revealed a nearly twofold increase in ECMO-related charges among patients who did not receive CPR (p = 0.04), as well as a trend toward improved survival (69.8% vs 51.1%, p = 0.06). In view of the variations in survival and costs in ECMO patients, further studies should aim to delineate patient populations that benefit from early initiation of ECMO.

The role of free radical oxidation and inflammation in the development of post-pericardiotomy syndrome after coronary heart disease artery bypass grafting

The purpose of this research was the clinical biochemical study of the role of the antioxidant system, products of lipid peroxidation and proinflammatory mediators in the mechanisms of development of postpericardiotomy syndrome. 50 patients who underwent coronary-artery bypass grafting were examined. They were divided into two groups: those without postpericardiotomy syndrome (1) and patients with this syndrome (2). The results suggest tension of the antioxidant system, overproduction of proinflammatory interleukin-6 and intensification of free radical oxidation in the patients undergoing direct myocardial revascularization.

Colchicine for prevention and treatment of cardiac diseases: A meta-analysis.

Colchicine has been suggested to be beneficial in preventing recurrent pericarditis. The goal of this study was to review all randomized controlled trials that assess the use of colchicine for the prevention and treatment of cardiac diseases. We performed a meta-analysis of the effects of colchicine on pericarditis, postpericardiotomy syndrome and postprocedural atrial fibrillation recurrence, in-stent restenosis, gastrointestinal adverse effects, and treatment discontinuation rates. We conducted an EMBASE and MEDLINE search for prospective controlled trials. We identified 17 prospective controlled randomized studies with 2082 patients that received colchicine and 1982 controls with an average follow-up duration of 12months. Treatment with colchicine is associated with reduced risk of pericarditis recurrence/postpericardiotomy syndrome (OR: 0.37; 95% CI: 0.29-0.47; P<0.001) and lower recurrence of atrial fibrillation rates after cardiac surgery and ablation procedures. However, gastrointestinal side effects were more common in patients treated with colchicine (OR: 2.6; 95% CI: 1.82-3.72; P<0.001) in all subgroups except for those treated for prevention of recurrent pericarditis. The higher rates of side effects resulted in higher incidence of treatment discontinuation in patients treated with colchicine. Colchicine appears to be efficacious and well tolerated for recurrent pericarditis/postpericardiotomy syndrome and recurrence of postprocedural atrial fibrillation. However, its efficacy may be limited by its gastrointestinal adverse events and treatment discontinuation rates particularly in postoperative patients.

Risk factors and prognosis of postpericardiotomy syndrome in patients undergoing valve surgery

ObjectiveThe study aim was to investigate the long-term prognosis and risk factors of postpericardiotomy syndrome (PPS). MethodsWe performed a single-center cohort study in 822 patients undergoing nonemergent valve surgery. Risk factors of PPS were evaluated using multivariable logistic regression analysis. We also compared the incidence of reoperation for tamponade at 1 year between patients with and without PPS. Main secondary outcomes were hospital stay and mortality. ResultsOf the 822 patients, 119 (14.5%) developed PPS. A higher body mass index (odds ratio (OR) per point increase, 0.94; 95% confidence interval (CI), 0.89-0.99) was associated with a lower risk of PPS, whereas preoperative treatment for pulmonary disease without corticosteroids (OR, 2.55; 95% CI, 1.25-5.20) was associated with a higher risk of PPS. The incidence of reoperation for tamponade at 1 year in PPS versus no PPS was 20.9% versus 2.5% (OR, 15.49; 95% CI, 7.14-33.58). One-year mortality in PPS versus no PPS was 4.2% versus 5.5% (OR, 0.68; 95% CI, 0.22-2.08). Median hospital stay was 13 days (interquartile range, 9-18 days) versus 11 days (interquartile range, 8-15 days) (P = .001), respectively. ConclusionsDespite longer hospital stays and more short-term reoperations for tamponade, patients with PPS had an excellent 1-year prognosis.

Post-pericardiotomy Syndrome.

Post-pericardiotomy syndrome (PPS) occurs in a subgroup of patients who have undergone cardiothoracic surgery and is characterized by fever, pleuritic pain, pleural effusion, and pericardial effusion. It is associated with significant morbidity, and the leading complications include tamponade and constrictive pericarditis. Epidemiologic studies have found that PPS often occurs among younger patients; however, there is a lack of comprehensive risk stratification. It is therefore important to be able to identify patients who are at high risk for developing this disease. The diagnosis is made if patients present with 2 out of the following 5 criteria; fever, pericardial or pleuritic chest pain, pericardial or pleural friction rub, pericardial effusion, and pleural effusion with elevated C-reactive protein (CRP). Pericardial effusion associated with PPS is detected by echocardiography, and cardiac MRI is used for evaluation of pericardial thickening as well as inflammation associated with PPS. These imaging modalities have been invaluable for monitoring the efficacy of treatment in PPS. Aspirin, nonsteroidal anti-inflammatory agents (NSAID), and colchicine are the mainstay of the current treatment for PPS. Although steroids are used for refractory cases of PPS, they are associated with significant side effects when used for long-term treatment of this disease. It is important for future research to focus on identification of clinical, serologic, and genetic markers that may predispose patients to PPS. There is also a need for clinical trials to address the use of targeted immunomodulatory treatment for this disease.

Registro de asistencia circulatoria y respiratoria (2007-2012): informe final del Grupo de Trabajo de Asistencia Mecánica Circulatoria de la SECTCV

The final Report of the Registry of circulatory and respiratory support of the SECTCV is presented. Since the beginning in 2007 until 2013 data from 15 centers were collected every year with 523 cases reported. The major objectives were ventricular recovery (56%) and bridge to transplant (40%) and major clinical indications were post-cardiotomy syndrome (114 cases), pre-transplant (113 cases) and post-myocardial infarction (94 cases). ECMO has been the most common mode of assistance and centrifugal pumps were the most frequent type of device.59% of devices were explanted due to ventricular recovery or transplantation. Hemorrhage-tamponade was the most frequent surgical morbidity and 30% of patients developed some degree of renal disfunction during ventricular assistance.The hospital mortality rate was 54% (281 patients, 196 patients with the device), the discharge rate after ventricular recovery was 69% and 79% after transplantation.

Recurrent pericarditis in children and adolescents: a multicentre cohort study.

Limited data are available about recurrent pericarditis in children. We sought to explore contemporary causes, characteristics, therapies and outcomes of recurrent pericarditis in paediatric patients. A multicentre (eight sites) cohort study of 110 consecutive cases of paediatric patients with at least two recurrences of pericarditis over an 11-year period (2000-2010) [median 13 years, interquartile range (IQR) 5, 69 boys]. Recurrences were idiopathic or viral in 89.1% of cases, followed by postpericardiotomy syndrome (9.1%) and familial Mediterranean fever (0.9%). Recurrent pericarditis was treated with nonsteroidal anti-inflammatory drugs (NSAIDs) in 80.9% of cases, corticosteroids in 64.8% and colchicine was added in 61.8%. Immunosuppressive therapies were administered in 15.5% of patients after subsequent recurrences. After a median follow-up of 60th months, 528 subsequent recurrences were recorded (median 3, range 2-25). Corticosteroid-treated patients experienced more recurrences (standardized risk of recurrence per 100 person-years was 93.2 for patients treated with corticosteroids and 45.2 for those without), side effects and disease-related hospitalizations (for all P < 0.05). Adjuvant therapy with colchicine was associated with a decrease in the risk of recurrence from 3.74 per year before initiation of colchicine to 1.37 per year after (P < 0.05). Anakinra therapy (n = 12) was associated with a drop in the number of recurrences from 4.29 per year before to 0.14 per year after (P < 0.05). Transient constrictive pericarditis developed in 2.7% of patients. Recurrent pericarditis has an overall favourable prognosis in children, although it may require frequent readmissions and seriously affect the quality of life, especially in patients treated with corticosteroids. Colchicine or anakinra therapies were associated with significant decrease in the risk of recurrence.

Kalp Cerrahisi Yapılan Hastalarda Erken Dönemde Gelişen Postperikardiyotomi Sendromu ve Atriyal Fibrilasyon Arasındaki İlişki

Kalp Cerrahisi Yapılan Hastalarda Erken Dönemde Gelişen Postperikardiyotomi Sendromu ve Atriyal Fibrilasyon Arasındaki İlişki

VA-ECMO in Cardiogenic Shock in Adults: Indications and Outcomes

&#x0D; &#x0D; &#x0D; Background&#x0D; Use of veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) has become increasingly common as a means of providing hemodynamic support for patients in cardiogenic shock. Data regarding the efficacy of VA-ECMO are provided almost exclusively by single-center, retrospective analyses. These retrospective analyses vary significantly with regards to documentation of the underlying pathophysiologic process resulting in cardiogenic shock.&#x0D; Methods&#x0D; Relevant published studies were identified by using a comprehensive search of English-language MEDLINE from 1966 to November 2015. Relevant references found cited in these studies were also analyzed. These studies were analyzed with regard to the indications the authors used for initiation of ECMO, as well as the outcomes for each indication in each individual study.&#x0D; Results&#x0D; Analysis of multiple relevant studies regarding the indications for ECMO support demonstrated that there is a great deal of variability with regard to the use of different indications for initiation of ECMO support.&#x0D; Conclusions&#x0D; Data regarding the efficacy of VA-ECMO is derived largely from single-center, retrospective analyses. In order to gain a better understanding of the efficacy of VA-ECMO in different patient populations, a more standardized format of documenting the indication for VA-ECMO should be used in centers that provide VA-ECMO. In general, all patients supported with VA-ECMO are in cardiogenic shock. In our experience, the underlying processes leading to cardiogenic shock can be classified as: cardiac arrest, acute decompensated congestive heart failure, acute on chronic congestive heart failure, myocardial infarction, acute pulmonary embolism, right ventricular failure not secondary to acute pulmonary embolism, and post-cardiotomy syndrome.&#x0D; &#x0D; &#x0D;

A CHANGING PARADIGM IN THE ETIOLOGY OF PERICARDIAL EFFUSIONS? A 12 YEAR STUDY OF PERICARDIOCENTESIS FROM THE CLEVELAND CLINIC

Etiologies for pericardial effusions have been well described with the majority of cases attributed to idiopathic, infectious and neoplastic causes. Effusion due to post-pericardiotomy syndrome (PPS) has not been reported as a common etiology. We describe the characteristics, etiologies and outcomes

Colchicine in addition to conventional therapy for pericarditis recurrence : An update meta-analysis.

Randomized controlled trials (RCTs) have investigated the use of colchicine and conventional therapy for reducing the recurrence of pericarditis in patients with acute pericarditis or post-pericardiotomy syndrome. However, the benefits of these treatments are variable. Studies were retrieved from PubMed, the Cochrane Library, and the EMBASE database. We identified nine RCTs with 1832patients and a mean follow-up of 13.1months. Overall, colchicine therapy significantly decreased the risk of pericarditis recurrence (odds ratio, OR 0.42; 95 % confidence interval, CI0.33-0.52; P < 0.001; I2 = 17.0 %). Colchicine therapy was associated with significantly lower rates of pericarditis-associated rehospitalization (OR 0.29; 95 %CI 0.16-0.53; P < 0.0001; I2 = 0.0 %) and persistence of symptoms (OR 0.29; 95 %CI, 0.21-0.41; P = 0.000; I2 = 0.0 %) at 72h. Adverse events were higher in the colchicine group (relative risk, RR 1.48; 95 %CI, 1.06-2.07; P = 0.02; I2 = 0.0 %). Subgroup analysis showed that recurrence of pericarditis was significantly lower in the colchicine therapy group, irrespective of prednisone use and the cause of pericarditis. Colchicine significantly decreases the rate of pericarditis recurrence, regardless of prednisone use and the cause of pericarditis. Larger studies are needed to confirm this effect.