Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
J Thorac Cardiovasc Surg. 2020 Dec;160(6):1446-1456. doi: 10.1016/j.jtcvs.2019.12.114. Epub 2020 Jan 28.
Postpericardiotomy syndrome (PPS) is a relatively common complication after cardiac surgery. However, long-term follow-up data on the adverse events and mortality of PPS patients requiring invasive interventions are scarce.
We sought to assess the occurrence of mortality, new-onset atrial fibrillation (AF), cerebrovascular events, and major bleeds in PPS patients requiring medical attention in a combination database of 671 patients who underwent isolated surgical aortic valve replacement with a bioprosthesis (n = 361) or mechanical prosthesis (n = 310) between 2002 and 2014 (Cardiovascular Research Consortium-A Prospective Project to Identify Biomarkers of Morbidity and Mortality in Cardiovascular Interventional Patients [CAREBANK] 2016-2018). PPS was defined as moderate if it resulted in delayed hospital discharge, readmission, or medical therapy because of the symptoms; and severe if it required interventions for the evacuation of pleural or pericardial effusion.
The overall incidence of PPS was 11.2%. Median time to diagnosis was 16 (interquartile range, 11-36) days. Severe PPS was diagnosed in 3.6% of patients. Severe PPS seemed to be associated with higher mortality (hazard ratio, 2.01; 95% confidence interval, 1.03-3.91; P = .040). Moderate or severe PPS increased the risk of new-onset AF during the early postoperative period (hazard ratio, 1.72; 95% confidence interval, 1.12-2.63; P = .012). No significant associations were found between PPS and cerebrovascular events or major bleeds during the follow-up.
Patients with PPS requiring invasive interventions are at increased risk for mortality unlike those with mild to moderate forms of the disease. PPS requiring medical attention is associated with a higher AF rate during the early postoperative period but has no significant effect on the occurrence of major stroke, stroke or transient ischemic attack, or major bleeds during long-term follow-up.
心包切开后综合征（PPS）是心脏手术后较为常见的并发症。然而，关于需要介入治疗的 PPS 患者不良事件和死亡率的长期随访数据却很少。
我们旨在评估 2002 年至 2014 年间在接受生物瓣（n=361）或机械瓣（n=310）的孤立性主动脉瓣置换术的 671 例患者的联合数据库中，因症状而需要医疗关注的 PPS 患者的死亡率、新发心房颤动（AF）、脑血管事件和大出血的发生情况（心血管研究联盟-前瞻性项目，以确定心血管介入患者发病和死亡的生物标志物[CAREBANK]，2016-2018 年）。如果 PPS 导致延迟出院、再入院或因症状而需要药物治疗，则定义为中度；如果需要干预以清除胸腔或心包积液，则定义为重度。
PPS 的总发生率为 11.2%。中位诊断时间为 16 天（四分位距，11-36 天）。3.6%的患者诊断为重度 PPS。重度 PPS 似乎与较高的死亡率相关（风险比，2.01；95%置信区间，1.03-3.91；P=0.040）。中度或重度 PPS 增加了术后早期新发 AF 的风险（风险比，1.72；95%置信区间，1.12-2.63；P=0.012）。在随访期间，未发现 PPS 与脑血管事件或大出血之间存在显著相关性。
与轻度至中度 PPS 患者不同，需要介入治疗的 PPS 患者的死亡率风险增加。需要医疗关注的 PPS 与术后早期更高的 AF 发生率相关，但对长期随访中主要中风、中风或短暂性脑缺血发作或大出血的发生没有显著影响。
