Post-Pericardiotomy Syndrome in Pediatric Patients Following Surgical Closure of Secundum Atrial Septal Defects: Incidence and Risk Factors

Abstract

Surgical repair for atrial septal defects (ASD) generally occurs during childhood. Post-pericardiotomy syndrome (PPS) after cardiac surgery has a reported incidence of 1-40 %. We focused exclusively on secundum ASD repair to evaluate the incidence of PPS. The purpose of this study is to determine the incidence of PPS after surgical repair of secundum ASD and investigate what risk factors may be predictive of its development. A retrospective study was performed, and 97 patients who underwent surgical closure of a secundum ASD were identified. 27 (28 %) were diagnosed with PPS within the first postoperative year. Diagnosis was made if they had evidence of new or worsening pericardial effusion and the presence of ≥2 of the following criteria: fever >72 h postoperatively, irritability, pleuritic chest pain, or pericardial friction rub. Closure of secundum ASDs was performed at a median age of 3.8 years (Interquartile Range (IQR): 2.2-6.0 years) and a median weight of 14.3 kilograms (IQR: 10.9-19.3 kilograms). The median time for development of PPS was 8 days post-op (IQR: 5-14). Significantly, 19 (27 %) of 70 patients in the non-PPS group had a small pericardial effusion on their discharge echocardiogram, while of the 27 patients who developed PPS, 17 (63 %) had a small pericardial effusion on their discharge echocardiogram (p = 0.001). PPS is relatively common following surgical closure of secundum ASDs. A small pericardial effusion on discharge echocardiogram is predictive of development of PPS postoperatively. In patients who develop PPS, there is a good response to therapy with a benign course.

Cost comparison of transcatheter and operative closures of ostium secundum atrial septal defects

“…Postpericardiotomy syndrome is a common complication of cardiac surgery, with an incidence of between 3% and 28% depending on the diagnostic criteria used. 14–17 As demonstrated in this study, PPS does not only incur economic cost but also can cause morbidity and, tragically, mortality. It thus should be considered in analyses comparing outcome after operative and transcatheter ASD closures.…”

Risk of Clinically Relevant Pericardial Effusion After Pediatric Cardiac Surgery

“…Treatment options are fluid restriction, diuretic use, corticosteroid therapy, non-steroidal anti-inflammatory drugs, and, in case of cardiac tamponade, (surgical) pericardial drainage [35]. Compared to other pediatric studies investigating PE [7, 8, 13–15, 36], treatment of patients with crPE in this study was mainly conservative or with diuretics, with corticosteroids prescribed for more severe cases. Yet, corticosteroids did not seem to influence the progression of crPE, since patients with and without corticosteroids still required pericardial drainage just as often (22.8% vs. 25.7%, p  = 0.71).…”

Postpericardiotomy syndrome after cardiac surgery

“…In the major PPS studies during the last decades, the reported incidences have been the following: 10-28% in children [32][33][34][35][36] and 9-21% in adults [8,12,13,37,38] with a median of 16% in adult patients [14]. In the recent Colchicine for Prevention of Postpericardiotomy Syndrome and Postoperative Atrial Fibrillation (COPPS-2) trial [7], the incidence in adult patients was as high as 29% in elderly patients, although the time limit of fever was abandoned resulting in a markedly higher occurrence during the first postoperative days compared to the Colchicine for the Prevention of the Post-pericardiotomy Syndrome (COPPS) trial [8].…”

“…PPS typically occurs within one month after the surgery, and an initial onset after six months is rare [5,12,13,26,[43][44][45][46][47]. In children, the onset is slightly earlier, typically within 1 to 2 weeks [11,33,35]. The median duration of the syndrome is 2-3 weeks [28,35,46], and possible relapses tend to occur within 2-11 weeks after the initial onset [44].…”