About 16% of sufferers have pericardial effusion that requires drainage inside 3 months after coronary heart valve surgical procedure, and EuroScore II is considerably related to an elevated threat for vital pericardial effusion in the course of the index admission, in accordance with analysis revealed in Open Coronary heart.
The retrospective, observational cohort examine included consecutive grownup sufferers (≥18 years) who underwent open coronary heart valve surgical procedure at a tertiary facility in Denmark from August 2013 to November 2017. Demographic and scientific information had been obtained from digital medical information and the Western Denmark Coronary heart Registry.
Vital pericardial effusion was the first examine end result and was outlined as requiring drainage or pericardiocentesis inside 3 months of surgical procedure.
A complete of 1460 sufferers (median age 71 years; 70% males) had coronary heart valve surgical procedure and had been included. Of the cohort, 62% of individuals had been identified with aortic valve stenosis, and the median size of keep was 9 days.
Within the 3-month follow-up, 230 sufferers (16%) had a major pericardial effusion—52% had been drained as a subxiphoid strategy and 48% as a parasternal/ultrasound-guided strategy. For 125 sufferers (54%), the drainage was performed earlier than discharge in the course of the index admission, and for 105 sufferers (46%) the drainage occurred after discharge.
Adjusted analyses confirmed that EuroScore II (hazard ratio [HR], 1.05; 95% CI, 1.02-1.08) was considerably related to an elevated threat for vital pericardial effusion in the course of the index admission. Rising age (HR, 0.97; 95% CI, 0.95-0.98 per yr) and concomitant coronary artery bypass grafting (CABG) vs remoted valve surgical procedure (HR, 0.58; 95% CI, 0.35-0.97) had been related to a decrease threat for vital pericardial effusion in the course of the index admission.
Male intercourse (HR, 2.30; 95% CI, 1.32-4.01) and aortic valve illness in contrast with mitral valve illness (HR, 2.16; 95% CI, 1.20-3.90) had been related to an elevated threat for vital pericardial effusion after discharge. Rising age (HR, 0.95; 95% CI 0.93-0.97), EuroScore II (HR, 0.80; 95% CI, 0.69-0.92), and concomitant CABG vs remoted valve surgical procedure (HR, 0.42; 95% CI, 0.21-0.82) had been considerably related to a decreased threat for vital pericardial effusion after discharge.
Research limitations embody the single-center, retrospective design, and that the timing of the elimination of pericardial drains may enhance the danger for vital pericardial effusions. The examine authors additionally famous that extra information on elements related to outcomes based mostly on potential designs are wanted earlier than drawing a causal conclusion.
“Figuring out sufferers prone to creating pericardial effusion could assist enhance postoperative administration following coronary heart valve surgical procedure,” the researchers commented.
Reference
Borregaard B, Sibilitz KL, Weiss MG, et al. Occurrence and predictors of pericardial effusion requiring invasive treatment following heart valve surgery. Open Coronary heart. Revealed on-line January 21, 2022. doi:10.1136/openhrt-2021-001880
