Primary prevention of post-pericardiotomy syndrome using corticosteroids: a systematic review

Abstract

Post-pericardiotomy syndrome is a well-recognized inflammatory phenomenon that commonly occurs in patients following cardiac surgery. Due to the increased morbidity and resource utilization associated with this condition, research has recently focused on ways of preventing its prevention this condition; primarily using colchicine, NSAIDs and corticosteroids. Areas covered: This systematic review summarizes the three clinical studies that have used corticosteroids for PPS primary prevention in the perioperative period. Due to the heterogeneity amongst these three studies in terms of population (both pediatric and adult patients), surgical procedure, administration regimen and results (only 1/3 studies reporting a positive effect), the effectiveness of corticosteroids remains unproven. Expert commentary: Corticosteroids have shown to be useful in the treatment of PPS but have thus far have shown mixed results as a primary prevention method. Research on patients taking corticosteroids pre-operatively have shown a significant reduction in the risk of developing PPS. Further research is required to determine if corticosteroids are helpful in preventing PPS in patient undergoing cardiac surgery, before any recommendations regarding their use in cardiovascular surgery can be made.

Circulating Biomarkers of Systemic Inflammatory Response in the Assessment of Postpericardiotomy Syndrome in Patients After Cardiac Surgery

“…TNFα levels vs other cytokines rise early that reflects its role as an initiator in the inflammatory response. TNFα is a mediator of various pathologies and involved in the "cytokine storm" [14]. The results of our study revealed no signi ficant inter-group differences in serum IL-1β levels, as well as significant changes in IL-1β between follow-up stages.…”

Postpericardiotomy syndrome after cardiac surgery

“…On the other hand, a retrospective study including overall 200 adult patients reported significant PPS reduction in patients receiving a single intraoperative dose of 1 mg/kg methylprednisolone (22.0% vs. 37.0%, p < 0.026) [79]. It has been suggested that the positive result conflicting with previous studies could be due to the strict exclusion criteria used [186]. Further large-scale studies are needed to assess the possible value of corticosteroids in the prevention of PPS maintaining special focus on the exact timing and route of the drug administration [186].…”

“…It has been suggested that the positive result conflicting with previous studies could be due to the strict exclusion criteria used [186]. Further large-scale studies are needed to assess the possible value of corticosteroids in the prevention of PPS maintaining special focus on the exact timing and route of the drug administration [186].…”

Postpericardiotomy syndrome: the role of genetic factors in the pathogenesis of a systemic inflammatory response after open-heart surgery

“…Вместе с тем, достоверных данных об эффективности назначения стероидных препаратов (дексаметазон в дозе 1 мг/кг) в предоперационном периоде не получено [2,14]. Наряду с этим, назначение колхицина приводило к снижению вероятности развития рецидивирующего перикардита в послеоперационном периоде [1,9].…”

“…Рост хирургической активности и сложности выполняемых операций на открытом сердце диктует необходимость выявления предикторов развития, совершенствования методов ранней диагностики и разработки новых подходов к профилактике одного из самых частых осложнений кардиохирургического вмешательства постперикардиотомного синдрома (ПКТС), который регистрируется у 9-65% больных [1][2][3]. Наряду с операциями на открытом сердце, развитие ПКТС описано при эндоваскулярных вмешательствах, таких как чрескожная коронарная ангиопластика со стентированием, радиочастотная катетерная аблация сердца, имплантация внутрисердечных устройств [4,5].…”