Year 2020 Vol. 28 No 5

LECTURES, REVIEWS

R.N. KOMAROV, N.O. KURASOV, A.M. ISMAILBAEV, A.O. DANACHEV

SYNDROME OF PERICARDIAL EXTENSION AND CARDIAC TAMPONADE AFTER OPEN CARDIOSURGICAL INTERVENTIONS

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow,
The Russian Federation

Postoperative effusion in the pericardium, which is also defined as postpericardial syndrome, is a common complication after open heart surgery. This condition directly affects the duration of hospitalization and the costs spent on treatment, and can also lead to life-threatening complications. Postoperative effusion in the pericardium can vary from slight (66-84%) to severe, defined as a cardiac tamponade (2.6%). The aim of this review is to consider etiopathogenesis, major risk factors, prevention and treatment of postoperative pericardial effusion. The development of cardiac tamponade is directly correlated with the type of intervention: 1.3% after coronary artery bypass graft, 6.6% after 1 valve replacement, 4.3% after several valves replacement, 2.5% after combined valve replacement and coronary artery bypass graft, 9.3% after thoracic aorta surgeries. The highest risk for developing cardiac tamponade accompanies patients after heart transplantation, interventions on the thoracic aorta and mechanical valve prosthetics. A proven and effective drug treatment strategy for the postoperative pericardial effusion syndrome is a combination of NSAIDs and colchicine. The posterior pericardiotomy is an effective and safe method for the prevention of this complication, and the most priority way to treat cardiac tamponade is echocardiographically controlled pericardiocentesis.

Keywords: postoperative pericardial effusion, postpericardiotomy syndrome, cardiac tamponade, posterior pericardiotomy, pericardiocentesis
p. 577-590 of the original issue
References
  1. Khan NK, Järvelä KM, Loisa EL, Sutinen JA, Laurikka JO, Khan JA. Incidence, presentation and risk factors of late postoperative pericardial effusions requiring invasive treatment after cardiac surgery. Interact Cardiovasc Thorac Surg. 2017 Jun 1;24(6):835-40. doi: 10.1093/icvts/ivx011
  2. Leiva EH, Carreño M, Bucheli FR, Bonfanti AC, Umaña JP, Dennis RJ. Factors associated with delayed cardiac tamponade after cardiac surgery. Ann Card Anaesth. 2018 Apr-Jun;21(2):158-166. doi: 10.4103/aca.ACA_147_17
  3. Sasse T, Eriksson U. Post-cardiac injury syndrome: aetiology, diagnosis, and treatment. E-Journal of Cardiology Practice [Electronic resource]. 2017; 15(21) [cited 2017 Oct 31]. Available from: https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Post-cardiac-injury-syndrome-aetiology-diagnosis
  4. Imazio M, Hoit B. Post-cardiac injury syndromes. An emerging cause of pericardial diseases. Int J Cardiol. 2013 Sep 30;168(2):648-52. doi: 10.1016/j.ijcard.2012.09.052
  5. Nomura Y, Yoshinaga M, Haraguchi T, Oku S, Noda T, Miyata K, Umebayashi Y, Taira A. Relationship between the degree of injury at operation and the change in antimyosin antibody titer in the postpericardiotomy syndrome. Pediatr Cardiol. 1994 May-Jun;15(3):116-20. doi: 10.1007/BF00796322
  6. Gouriet F, Levy PY, Casalta JP, Zandotti C, Collart F, Lepidi H, Cautela J, Bonnet JL, Thuny F, Habib G, Raoult D. Etiology of Pericarditis in a Prospective Cohort of 1162 Cases. Am J Med. 2015 Jul;128(7):784.e1-8. doi: 10.1016/j.amjmed.2015.01.040
  7. Mangi AA, Palacios IF, Torchiana DF. Catheter pericardiocentesis for delayed tamponade after cardiac valve operation. Ann Thorac Surg. 2002 May;73(5):1479-83. doi: 10.1016/s0003-4975(02)03495-1
  8. Alraies MC, AlJaroudi W, Shabrang C, Yarmohammadi H, Klein AL, Tamarappoo BK. Clinical features associated with adverse events in patients with post-pericardiotomy syndrome following cardiac surgery. Am J Cardiol. 2014 Nov 1;114(9):1426-30. doi: 10.1016/j.amjcard.2014.07.078
  9. Shabetai R. Pericardial effusion: haemodynamic spectrum. Heart. 2004 Mar;90(3):255-56. doi: 10.1136/hrt.2003.024810
  10. Sagristà-Sauleda J, Angel J, Permanyer-Miralda G, Soler-Soler J. Long-term follow-up of idiopathic chronic pericardial effusion. N Engl J Med. 1999 Dec 30;341(27):2054-59. doi: 10.1056/NEJM199912303412704
  11. Reddy PS, Curtiss EI, Uretsky BF. Spectrum of hemodynamic changes in cardiac tamponade. Am J Cardiol. 1990 Dec 15;66(20):1487-91. doi: 10.1016/0002-9149(90)90540-h
  12. Adrichem R, Le Cessie S, Hazekamp MG, Van Dam NAM, Blom NA, Rammeloo LAJ, Filippini LHPM, Kuipers IM, Ten Harkel ADJ, Roest AAW. Risk of clinically relevant pericardial effusion after pediatric cardiac surgery. Pediatr Cardiol. 2019 Mar;40(3):585-94. doi: 10.1007/s00246-018-2031-4
  13. Ashikhmina EA, Schaff HV, Sinak LJ, Li Z, Dearani JA, Suri RM, Park SJ, Orszulak TA, Sundt TM 3rd. Pericardial effusion after cardiac surgery: risk factors, patient profiles, and contemporary management. Ann Thorac Surg. 2010 Jan;89(1):112-18. doi: 10.1016/j.athoracsur.2009.09.026
  14. You SC, Shim CY, Hong GR, Kim D, Cho IJ, Lee S, Chang HJ, Ha JW, Chang BC, Chung N. Incidence, Predictors, and Clinical Outcomes of Postoperative Cardiac Tamponade in Patients Undergoing Heart Valve Surgery. PLoS One. 2016 Nov 17;11(11):e0165754. doi: 10.1371/journal.pone.0165754. eCollection 2016.
  15. Pompilio G, Filippini S, Agrifoglio M, Merati E, Lauri G, Salis S, Alamanni F, Parolari A. Determinants of pericardial drainage for cardiac tamponade following cardiac surgery. Eur J Cardiothorac Surg. 2011 May;39(5):e107-13. doi: 10.1016/j.ejcts.2010.12.021
  16. Price S, Prout J, Jaggar SI, Gibson DG, Pepper JR. Tamponade following cardiac surgery: terminology and echocardiography may both mislead. Eur J Cardiothorac Surg. 2004 Dec;26(6):1156-60. doi: 10.1016/j.ejcts.2004.08.020
  17. Yu Z, Kittleson M, Patel J, Liou F, Yabuno J, Piponniau L, Chang D, Czer L, Azarbal B, Esmailian F, Kobashigawa J. Moderate pericardial effusions after heart transplant: do they require proactive intervention? Transplantation. 2014 Jul 15;98(Is):427. https://journals.lww.com/transplantjournal/fulltext/2014/07151/moderate_pericardial_effusions_after_heart.1417.aspx
  18. Vandenberg BF, Mohanty PK, Craddock KJ, Barnhart G, Hanrahan J, Szentpetery S, Lower RR. Clinical significance of pericardial effusion after heart transplantation. J Heart Transplant. 1988 Mar-Apr;7(2):128-34. https://pubmed.ncbi.nlm.nih.gov/3284984
  19. Hauptman PJ, Couper GS, Aranki SF, Kartashov A, Mudge GH Jr, Loh E. Pericardial effusions after cardiac transplantation. J Am Coll Cardiol. 1994 Jun;23(7):1625-29. doi: 10.1016/0735-1097(94)90666-1
  20. Eryilmaz S, Emiroglu O, Eyileten Z, Akar R, Yazicioglu L, Tasoz R, Kaya B, Uysalel A, Ucanok K, Corapcioglu T, Ozyurda U. Effect of posterior pericardial drainage on the incidence of pericardial effusion after ascending aortic surgery. J Thorac Cardiovasc Surg. 2006 Jul;132(1):27-31. doi: 10.1016/j.jtcvs.2006.01.049
  21. Floerchinger B, Camboni D, Schopka S, Kolat P, Hilker M, Schmid C. Delayed cardiac tamponade after open heart surgery is supplemental CT imaging reasonable? J Cardiothorac Surg. 2013 Jun 24;8:158. doi: 10.1186/1749-8090-8-158
  22. Kaya M, Iyigün T, Yazıcı P, Melek Y, Göde S, Güler S, Karaçalılar M, Satılmışoğlu MH, Erek E. The effects of posterior pericardiotomy on pericardial effusion, tamponade, and atrial fibrillation after coronary artery surgery. Kardiochir Torakochirurgia Pol. 2014 Jun;11(2):113-18. doi: 10.5114/kitp.2014.43835
  23. Haqzad Y, Loubani M, Shah S. Short and long-term outcomes of re-exploration for bleeding/tamponade in CABG patients: up to 18 years follow up. SCTS Annual Meeting [Electronic resource]. 2018: Poster 112. Available from: https://www.myeventflo.com/event-lecture.asp?lectID=15090
  24. Malouf JF, Alam S, Gharzeddine W, Stefadouros MA. The role of anticoagulation in the development of pericardial effusion and late tamponade after cardiac surgery. Eur Heart J. 1993 Nov;14(11):1451-57. doi: 10.1093/eurheartj/14.11.1451
  25. Watkin RW, Harper LV, Vernallis AB, Lang S, Lambert PA, Ranasinghe AM, Elliott TS. Pro-inflammatory cytokines IL6, TNF-alpha, IL1beta, procalcitonin, lipopolysaccharide binding protein and C-reactive protein in infective endocarditis. J Infect. 2007 Sep;55(3):220-25. doi: 10.1016/j.jinf.2007.05.174
  26. Regueiro A, Falces C, Cervera C, Del Rio A, Paré JC, Mestres CA,Castañeda X, Pericàs JM, Azqueta M, Marco F, Ninot S, Almela M, Moreno A, Miró JM. Risk factors for pericardial effusion in native valve infective endocarditis and its influence on outcome. Am J Cardiol. 2013 Sep 23;112(10):1646-51. 10.1016/j.amjcard.2013.07.024
  27. Maesen B, Nijs J, Maessen J, Allessie M, Schotten U. Post-operative atrial fibrillation: a maze of mechanisms. Europace. 2012 Feb;14(2):159-74. doi: 10.1093/europace/eur208
  28. Siliato-Robles MS, Gracia-Baena JM, Sureda-Barbosa JC, Igual-Barceló A. Delayed cardiac tamponade after catheter ablation therapy due to a Valsalva manoeuvre. Eur J Cardiothorac Surg. 2019 Feb 1;55(2):369-70. doi: 10.1093/ejcts/ezy232
  29. Dalili M, Zamani H, Aarabi-Moghaddam M. Pericardial effusion after pediatric cardiac surgeries: a single center observation. Res Cardiovasc Med. 2012 Nov;1(1):28-32. doi: 10.5812/cardiovascmed.4601
  30. Khandaker MH, Espinosa RE, Nishimura RA, Sinak LJ, Hayes SN, Melduni RM, Oh JK. Pericardial disease: diagnosis and management. Mayo Clin Proc. 2010 Jun;85(6):572-93. doi: 10.4065/mcp.2010.0046
  31. Meurin P, Tabet JY, Thabut G, Cristofini P, Farrokhi T, Fischbach M, Pierre B, Driss AB, Renaud N, Iliou MC, Weber H. Nonsteroidal anti-inflammatory drug treatment for postoperative pericardial effusion: a multicenter randomized, double-blind trial. Ann Intern Med. 2010 Feb 2;152(3):137-43. doi: 10.7326/0003-4819-152-3-201002020-00004
  32. Horneffer PJ, Miller RH, Pearson TA, Rykiel MF, Reitz BA, Gardner TJ. The effective treatment of postpericardiotomy syndrome after cardiac operations. A randomized placebo-controlled trial. J Thorac Cardiovasc Surg. 1990 Aug;100(2):292-96. https://pubmed.ncbi.nlm.nih.gov/2200931
  33. Imazio M, Bobbio M, Cecchi E, Demarie D, Demichelis B, Pomari F, Moratti M, Gaschino G, Giammaria M, Ghisio A, Belli R, Trinchero R. Colchicine in addition to conventional therapy for acute pericarditis: results of the COlchicine for acute PEricarditis (COPE) trial. Circulation. 2005 Sep 27;112(13):2012-16. doi: 10.1161/CIRCULATIONAHA.105.542738
    354 Melvan JN, Madden D, Vasquez JC, DeLaRosa J. Computed Tomography-guided Pericardiocentesis: An alternative approach for accessing the pericardium. Heart Lung Circ. 2016 Jul;25(7):725-28. doi: 10.1016/j.hlc.2016.01.004
  34. Çelik S, Lestuzzi C, Cervesato E, Dequanter D, Piotti P, De Biasio M, Imazio M. Systemic chemotherapy in combination with pericardial window has better outcomes in malignant pericardial effusions. J Thorac Cardiovasc Surg. 2014 Nov;148(5):2288-93. doi: 10.1016/j.jtcvs.2014.04.031
  35. Izadi Amoli A, Bozorgi A, HajHossein Talasaz A, Salehi Omran A, Mortazavi SH, Jalali A, Nasirpour S, Jenab Y. Efficacy of colchicine versus placebo for the treatment of pericardial effusion after open-heart surgery: A randomized, placebo-controlled trial. Am Heart J. 2015 Dec;170(6):1195-201. doi: 10.1016/j.ahj.2015.09.020
  36. Maisch B, Ristić AD. Practical aspects of the management of pericardial disease. Heart. 2003 Sep;89(9):1096-103. doi: 10.1136/heart.89.9.1096
  37. Gozdek M, Pawliszak W, Hagner W, Zalewski P, Kowalewski J, Paparella D, Carrel T, Anisimowicz L, Kowalewski M. Systematic review and meta-analysis of randomized controlled trials assessing safety and efficacy of posterior pericardial drainage in patients undergoing heart surgery. J Thorac Cardiovasc Surg. 2017 Apr;153(4):865-875.e12. doi: 10.1016/j.jtcvs.2016.11.057
  38. Kaleda VI, McCormack DJ, Shipolini AR. Does posterior pericardiotomy reduce the incidence of atrial fibrillation after coronary artery bypass grafting surgery? Interact Cardiovasc Thorac Surg. 2012 Apr;14(4):384-89. doi: 10.1093/icvts/ivr099
  39. Crystal E, Garfinkle MS, Connolly SS, Ginger TT, Sleik K, Yusuf SS. Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD003611. doi: 10.1002/14651858.CD003611.pub2
  40. Creswell LL, Alexander JC Jr, Ferguson TB Jr, Lisbon A, Fleisher LA; American College of Chest Physicians. Intraoperative interventions: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest. 2005 Aug;128(2 Suppl):28S-35S. doi: 10.1378/chest.128.2_suppl.28s
  41. Dunning J, Treasure T, Versteegh M, Nashef SA; EACTS Audit and Guidelines Committee. Guidelines on the prevention and management of de novo atrial fibrillation after cardiac and thoracic surgery. Eur J Cardiothorac Surg. 2006 Dec;30(6):852-72. doi: 10.1016/j.ejcts.2006.09.003
  42. Farsak B, Günaydin S, Tokmakoğlu H, Kandemir Ö, Yorgancioğlu C, Zorlutuna Y. Posterior pericardiotomy reduces the incidence of supra-ventricular arrhythmias and pericardial effusion after coronary artery bypass grafting. Eur Cardiothorac Surg. 2002 Aug;22(Is 2):278-81. doi: 10.1016/S1010-7940(02)00259-2
  43. Haddadzadeh M, Motavaselian M, Rahimianfar AA, Forouzannia SK, Emami M, Barzegar K. The effect of posterior pericardiotomy on pericardial effusion and atrial fibrillation after off-pump coronary artery bypass graft. Acta Med Iran. 2015;53(1):57-61. https://journals.research.ac.ir/files/site1/rds_journals/56/article-56-29898.pdf
  44. Mulay A, Kirk AJ, Angelini GD, Wisheart JD, Hutter JA. Posterior pericardiotomy reduces the incidence of supra-ventricular arrhythmias following coronary artery bypass surgery. Eur J Cardiothorac Surg. 1995;9(3):150-52. doi: 10.1016/s1010-7940(05)80063-6
  45. Callahan JA, Seward JB, Nishimura RA, Miller FA Jr, Reeder GS, Shub C, Callahan MJ, Schattenberg TT, Tajik AJ. Two-dimensional echocardiographically guided pericardiocentesis: experience in 117 consecutive patients. Am J Cardiol. 1985 Feb 1;55(4):476-79. doi: 10.1016/0002-9149(85)90397-2
  46. Martin R, Rakowski H, French J, Popp R. Localization of pericardial effusion with wide angle phased array echocardiography. Am J Cardiol. 1978 Dec;42(6):904-12. doi: 10.1016/0002-9149(78)90674-4
  47. Maggiolini S, Gentile G, Farina A, De Carlini CC, Lenatti L, Meles E, Achilli F, Tempesta A, Brucato A, Imazio M. Safety, efficacy, and complications of pericardiocentesis by real-time echo-monitored procedure. Am J Cardiol. 2016 Apr 15;117(8):1369-74. doi: 10.1016/j.amjcard.2016.01.043
  48. Tsang TS, Enriquez-Sarano M, Freeman WK, Barnes ME, Sinak LJ, Gersh BJ, Bailey KR, Seward JB. Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and outcomes spanning 21 years. Mayo Clin Proc. 2002 May;77(5):429-36. doi: 10.4065/77.5.429
  49. Neves D, Silva G, Morais G, Ferreira N, Carvalho M, Gama Ribeiro V, Bettencourt N. Computed tomography-guided pericardiocentesis - A single-center experience. Rev Port Cardiol. 2016 May;35(5):285-90. doi: 10.1016/j.repc.2015.11.015
  50. Bruning R, Muehlstaedt M, Becker C, Knez A, Haberl R, Reiser M. Computed tomography-fluoroscopy guided drainage of pericardial effusions: experience in 11 cases. Invest Radiol. 2002 Jun;37(6):328-32. doi: 10.1097/00004424-200206000-00004
  51. Tam A, Ensor JE, Snyder H, Gupta S, Durand JB, Wallace MJ. Image-guided drainage of pericardial effusions in oncology patients. Cardiovasc Intervent Radiol. 2009 Nov;32(6):1217-26. doi: 10.1007/s00270-009-9594-7
  52. Alp I, Ugur M, Selcuk I, Ulucan AE, Temizkan V, Yilmaz AT. Safety Pericardiocentesis with Fluoroscopy Following Cardiac Surgery. Ann Thorac Cardiovasc Surg. 2019 Jun 20;25(3):158-63. doi: 10.5761/atcs.oa.18-00188
  53. Refat A, Abdelsayed A. Does the position of the drains after open heart surgery make a difference? A clinical randomized trial. J Egyp Soc CardioThorac Surg. 2018 Dec;26(4):281-86. doi: 10.1016/j.jescts.2018.10.002
Address for correspondence:
119435, Russian Federation,
Moscow, Bolshaya Pirogovskaya str., 6-1,
I.M. Sechenov First Moscow
State Medical University,
the Faculty Surgery Department No1,
tel. +7 926 816-47-37,
e-mail: danachev@gmail.com,
Danachev Alexander O.
Information about the authors:
Komarov Roman N., MD, Head of the Faculty Surgery Department No1, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-3904-6415
Kurasov Nikolay O., Assistant of the Faculty Surgery Dpartment No1, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0001-6269-2207
Ismailbaev Alisher M., PhD, Assistant of the Faculty Surgery Department No1, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0001-8545-3276
Danachev Alexander O., the Three-Year Post-Graduate Student, the Faculty Surgery Department No1, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0001-9296-3119
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