| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2002;74:1148-1153
© 2002 The Society of Thoracic Surgeons
a Department of Medicine, Division of Cardiology, Tufts New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts, USA
b Department of Surgery, Division of Cardiothoracic Surgery, Tufts New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts, USA
Accepted for publication May 29, 2002.
* Address reprint requests to Dr Khabbaz, Division of Cardiothoracic Surgery, Tufts New England Medical Center Hospitals, 750 Washington St, Box 276, Boston, MA 02111, USA
e-mail: kkhabbaz{at}lifespan.org
Background. Pericardial effusions resulting in cardiac tamponade (CT) are uncommon after open heart surgery (OHS) and are associated with significant morbidity and mortality. Characteristics and outcomes of patients who develop postoperative CT are poorly defined. Our objective was to further analyze the population at risk for developing postoperative CT, identify potential perioperative and surgical risk factors, and evaluate the impact of CT on patient outcomes.
Methods. A retrospective analysis of 4,561 consecutive patients undergoing OHS at our institution was performed. Patients with clinical suspicion of pericardial effusion following surgery were evaluated by transthoracic or transesophageal echocardiography, and clinical parameters were analyzed.
Results. Forty-eight (1%) of the 4,561 patients were found to have echocardiographic evidence of a moderate or large pericardial effusion, of whom 36 (74%) had evidence of CT. The mean age of the patients with CT was 61 years. Coronary artery bypass grafting (CABG) had been performed in 24% of these patients, valve ± CABG in 73%, and other OHS procedures in 3%. The incidence of CT following CABG alone was 0.2%, whereas it was 0.6% after valve ± CABG. Females had a higher risk for developing CT, and this occurred earlier in the postoperative period when compared with men. Aspirin, heparin, or warfarin were given to 84% of patients within 3 days of surgery. Mean time to diagnosis of CT was 10 ± 1 days after OHS. Prior to diagnosis of CT, the maximum international normalized ratio (INR) and partial thromboplastin time (PTT) were 2.7 ± 0.3 and 68 ± 5 seconds, respectively. Forty-nine percent of pericardial effusions were posterior and 46% were circumferential; one-third of the effusions were considered large by echocardiography. There was one in-hospital cardiovascular death.
Conclusions. CT after OHS is more common following valve surgery than CABG alone and may be related to the preoperative use of anticoagulants. Females appear to be at higher risk for developing early postoperative CT. When diagnosed and treated promptly, postoperative CT should not significantly increase mortality.
This article has been cited by other articles:
|
|
 |
|
  J. Wacker, G. Djaiani, R. Katznelson, and J. Karski External compression of superior vena cava after the replacement of ascending aorta Eur J Echocardiogr, July 1, 2008; 9(4): 589 - 590. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Chumnanvej, M. J. Wood, T. E. MacGillivray, and M. F. V. Melo Perioperative Echocardiographic Examination for Ventricular Assist Device Implantation Anesth. Analg., September 1, 2007; 105(3): 583 - 601. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. L. Roy, M. A. Minor, M. A. Brookhart, and N. K. Choudhry Does This Patient With a Pericardial Effusion Have Cardiac Tamponade? JAMA, April 25, 2007; 297(16): 1810 - 1818. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Eryilmaz, O. Emiroglu, Z. Eyileten, R. Akar, L. Yazicioglu, R. Tasoz, B. Kaya, A. Uysalel, K. Ucanok, T. Corapcioglu, et al. Effect of posterior pericardial drainage on the incidence of pericardial effusion after ascending aortic surgery J. Thorac. Cardiovasc. Surg., July 1, 2006; 132(1): 27 - 31. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. A. Frazier, F. Qureshi, K. M. Read, R. C. Gilkeson, R. S. Poston, and C. S. White Coronary Artery Bypass Grafts: Assessment with Multidetector CT in the Early and Late Postoperative Settings RadioGraphics, July 1, 2005; 25(4): 881 - 896. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Meurin, H. Weber, N. Renaud, F. Larrazet, J. Y. Tabet, P. Demolis, and A. Ben Driss Evolution of the Postoperative Pericardial Effusion After Day 15: The Problem of the Late Tamponade Chest, June 1, 2004; 125(6): 2182 - 2187. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Task Force members, B. Maisch, P. M. Seferovic, A. D. Ristic, R. Erbel, R. Rienmuller, Y. Adler, W. Z. Tomkowski, G. Thiene, M. H. Yacoub, et al. Guidelines on the Diagnosis and Management of Pericardial Diseases Executive Summary: The Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology Eur. Heart J., April 1, 2004; 25(7): 587 - 610. [Full Text] [PDF]
|
|
|
|
 |
|
 E W Y Cheung, S A Ho, K K Y Tang, A K T Chau, C S W Chiu, and Y F Cheung Pericardial effusion after open heart surgery for congenital heart disease Heart, July 1, 2003; 89(7): 780 - 783. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
