Departments of Cardiovascular Surgery, Postoperative Intensive Care Unit, Coronary Intensive Care Unit, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milano, Italy.
Eur J Cardiothorac Surg. 2011 May;39(5):e107-13. doi: 10.1016/j.ejcts.2010.12.021. Epub 2011 Feb 3.
We aimed to identify independent risk factors predisposing toward postoperative surgical or percutaneous pericardial drainage following cardiac surgery, and to assess late survival.
A retrospective review of preoperative, intra-operative and postoperative variables was conducted in 5818 patients, who underwent adult heart surgery in a 7-year time span (2002-2009). Pericardial drainage was performed in 117 patients (2%), of whom 52 (44%) were evacuated by surgical drainage and 65 (56%) by echocardiographic-guided pericardiocentesis. Patients were divided in two groups: patients with two-dimensional (2D) echocardiographic evidence of cardiac tamponade, who underwent pericardial surgical or percutaneous drainage (group I: 117 patients); and patients without cardiac tamponade (group II: 5701 patients), who served as the control group.
The two groups were compared with univariate analysis, and variables significantly (p ≤ 0.05) or possibly (p ≤ 0.2) associated with pericardial drainage were entered into multivariable logistic regression analysis models assessing the role of pre-, intra- and postoperative variables together or separately. Pericardial drainage was more likely to occur in patients undergoing combined procedures such as double/triple valves or surgery on ascending aorta, in patients with higher EuroSCORE (European System for Cardiac Operative Risk Evaluation) levels, whereas patients receiving aspirin treatment before surgery had a lower risk of this complication. In addition, postoperative blood product transfusion and the occurrence of renal failure after surgery increased the risk of this complication.
Postoperative pericardial drainage is an uncommon complication after heart surgery, mainly managed percutaneously. Our study has identified different independent causative factors for cardiac tamponade requiring pericardiocentesis. The identification of preoperative and postoperative risk factors may be useful to adopt strategies to further reduce the incidence of pericardial tamponade requiring drainage.
本研究旨在确定心脏手术后行外科或经皮心包引流的独立危险因素，并评估晚期生存率。
对 5818 例行成人心脏手术的患者进行了回顾性分析，研究时间为 7 年（2002-2009 年）。5818 例患者中，心包引流 117 例（2%），其中 52 例（44%）经外科引流，65 例（56%）经超声心动图引导下心包穿刺引流。将患者分为两组：二维（2D）超声心动图证实有心包填塞的患者，行心包外科或经皮引流（组 I：117 例）；无心脏压塞的患者（组 II：5701 例）作为对照组。
对两组进行单因素分析，对差异有统计学意义（p≤0.05）或有统计学意义（p≤0.2）的变量进行多变量逻辑回归分析，评估术前、术中和术后变量联合或单独作用。心包引流更可能发生在接受联合手术（如双瓣或升主动脉手术）、欧洲心脏手术风险评估系统（EuroSCORE）评分较高的患者中，而术前接受阿司匹林治疗的患者发生该并发症的风险较低。此外，术后输血和术后肾功能衰竭增加了该并发症的风险。
心脏手术后心包引流是一种罕见的并发症，主要通过经皮途径处理。本研究确定了需要心包穿刺引流的心包填塞的不同独立致病因素。术前和术后危险因素的识别可能有助于进一步降低需要引流的心包填塞的发生率。
