Urbanowicz Tomasz, Staburzyńska-Migaj Ewa, Pawłowska Magdalena, Żabicki Bartosz, Michalak Michał, Filipiak Marlena, Grajek Stefan, Jemielity Marek
Department of Cardiac Surgery and Transplantology, Chair of Cardio-Thoracic Surgery, Poznań University of Medical Sciences, Poznań, Poland.
Department of Cardiology, Poznań University of Medical Sciences, Poznań, Poland.
Ann Transplant. 2015 Apr 6;20:193-7. doi: 10.12659/AOT.892582.
Pericardial effusion is an early complication following orthotopic heart transplantation. Effusion that requires surgical intervention not only prolongs in-hospital stay but also increases early mortality rate. EuroSCORE is one of the most common methods for calculating predictive mortality in heart surgery.
We performed a retrospective analysis of 25 patients (22 men and 3 women, mean age 49±12 years). Mortality risk by EuroSCORE was estimated prior to surgery. All patients were operated on with Lower-Shumway technique and treated with standard triple immunosuppressive regimen (tacrolimus, mycophenolate mofetil, and prednisolone). They were divided into 2 groups depending on postoperative pericardial effusion that required surgical intervention. There were 9 (36%) patients in the pericardial effusion group (PE group) and 16 (64%) in the control group (C group).
There was 1 death, on the 7th postoperative day, due to Clostridium difficile infection. Mean time of pericardial effusion echocardiographic detection was 9±2 days following surgery. The mean amount of fluid diagnosed in 4-chamber transthoracic echocardiography was 2.2±0.3 cm vs. 0.7±0.2 cm (p<0.05). Pericardial effusion followed thrombocytopenia of 98±17 vs. 172±26×10⁹/L in PE and C group (p<0.05). Patients' mean intensive care unit time stay was 23±9 days and 11±7 days in PE and C group, respectively (p<0.05). The overall hospitalization time was 38±12 days and 31±23 days in PE and C group, respectively (p<0.05). The discriminant analysis showed that EuroSCORE >16% is a single predicting variable for postoperative pericardial effusion (AUC 0.946, CI: 0.76-0.99).
Pericardial effusion is a common (36%) complication following heart transplantation. It requires surgical intervention and prolongs intensive care unit stay and overall hospitalization. The discriminant analysis showed that the EuroSCORE >16% is a single predicting variable for postoperative pericardial effusion.
心包积液是原位心脏移植后的早期并发症。需要手术干预的积液不仅会延长住院时间，还会增加早期死亡率。欧洲心脏手术风险评估系统（EuroSCORE）是心脏手术中计算预测死亡率最常用的方法之一。
我们对25例患者（22例男性和3例女性，平均年龄49±12岁）进行了回顾性分析。术前通过EuroSCORE评估死亡风险。所有患者均采用Lower-Shumway技术进行手术，并接受标准的三联免疫抑制方案（他克莫司、霉酚酸酯和泼尼松龙）治疗。根据术后是否需要手术干预的心包积液情况将患者分为2组。心包积液组（PE组）有9例（36%）患者，对照组（C组）有16例（64%）患者。
有1例患者在术后第７天因艰难梭菌感染死亡。心包积液的超声心动图检测平均时间为术后9±2天。经胸超声心动图四腔心切面诊断的平均液量在PE组为2.2±0.3 cm，而在C组为0.7±0.2 cm（p<0.05）。心包积液患者血小板减少，PE组为98±17×10⁹/L，C组为172±26×10⁹/L（p<0.05）。PE组和C组患者在重症监护病房的平均停留时间分别为23±9天和11±7天（p<0.05）。PE组和C组的总住院时间分别为38±12天和31±23天（p<0.05）。判别分析显示，EuroSCORE>16%是术后心包积液的单一预测变量（曲线下面积0.946，可信区间：0.76-0.99）。
心包积液是心脏移植后常见（36%）的并发症。它需要手术干预，并延长重症监护病房停留时间和总住院时间。判别分析显示，EuroSCORE>16%是术后心包积液的单一预测变量。
