Leiva Edgar Hernández, Carreño Marisol, Bucheli Fernando Rada, Bonfanti Alberto Cadena, Umaña Juan Pablo, Dennis Rodolfo José
Department of Cardiology, Instituto de Cardiología-Fundación Cardioinfantil, Universidad del Rosario, Bogotà DC, Colombia.
Department of Cardiovascular Surgery, Instituto de Cardiología-Fundación Cardioinfantil, Universidad del Rosario, Bogotà DC, Colombia.
Ann Card Anaesth. 2018 Apr-Jun;21(2):158-166. doi: 10.4103/aca.ACA_147_17.
Cardiac tamponade (CT) following cardiac surgery is a potentially fatal complication and the cause of surgical reintervention in 0.1%-6% of cases. There are two types of CT: acute, occurring within the first 48 h postoperatively, and subacute or delayed, which occurs more than 48 h postoperatively. The latter does not show specific clinical signs, which makes it more difficult to diagnose. The factors associated with acute CT (aCT) are related to coagulopathy or surgical bleeding, while the variables associated with subacute tamponade have not been well defined.
The primary objective of this study was to identify the factors associated with the development of subacute CT (sCT).
This report describes a case (n = 80) and control (n = 160) study nested in a historic cohort made up of adult patients who underwent any type of urgent or elective cardiac surgery in a tertiary cardiovascular hospital. Methods: The occurrence of sCT was defined as the presence of a compatible clinical picture, pericardial effusion and confirmation of cardiac tamponade during the required emergency intervention at any point between 48 hours and 30 days after surgery. All factors potentially related to the development of sCT were taken into account.
For the adjusted analysis, a logistical regression was constructed with 55 variables, including pre-, intra-, and post-operative data.
The mortality of patients with sCT was 11% versus 0% in the controls. Five variables were identified as independently and significantly associated with the outcome: pre- or post-operative anticoagulation, reintervention in the first 48 h, surgery other than coronary artery bypass graft, and red blood cell transfusion.
Our study identified five variables associated with sCT and established that this complication has a high mortality rate. These findings may allow the implementation of standardized follow-up measures for patients identified as higher risk, leading to either early detection or prevention.
心脏手术后的心包填塞（CT）是一种潜在的致命并发症，在0.1%-6%的病例中是手术再次干预的原因。CT有两种类型：急性型，发生在术后48小时内；亚急性或延迟型，发生在术后48小时以上。后者没有特定的临床体征，这使得其诊断更加困难。与急性CT（aCT）相关的因素与凝血功能障碍或手术出血有关，而与亚急性心包填塞相关的变量尚未明确界定。
本研究的主要目的是确定与亚急性CT（sCT）发生相关的因素。
本报告描述了一项病例（n = 80）对照（n = 160）研究，该研究嵌套于一个历史性队列中，该队列由在一家三级心血管医院接受任何类型急诊或择期心脏手术的成年患者组成。方法：sCT的发生定义为在术后48小时至30天之间的任何时间进行所需的紧急干预时，出现符合临床表现、心包积液并确诊为心包填塞。考虑了所有可能与sCT发生相关的因素。
为了进行校正分析，构建了一个包含55个变量的逻辑回归模型，包括术前、术中和术后数据。
sCT患者的死亡率为11%，而对照组为0%。确定了五个变量与该结果独立且显著相关：术前或术后抗凝、术后48小时内再次干预、非冠状动脉搭桥手术以及红细胞输血。
我们的研究确定了与sCT相关的五个变量，并确定这种并发症具有高死亡率。这些发现可能有助于对被确定为高风险的患者实施标准化的随访措施，从而实现早期检测或预防。
