The Effect of Short-Term Prophylactic Acetylsalicylic Acid on the Incidence of Postpericardiotomy Syndrome After Surgical Closure of Atrial Septal Defects

Abstract

Postpericardiotomy syndrome (PPS), a potential complication of open heart surgery, has a variable clinical course and severity. This study evaluated the effectiveness of acetylsalicylic acid (ASA) prophylaxis in preventing PPS after surgical closure of atrial septal defects (ASDs) in pediatric patients. A retrospective review was performed for 177 patients who underwent uncomplicated ASD closure from 1986 to 2006. The study group received prophylactic ASA 20 to 50 mg/kg/day for 1 to 6 weeks after surgery, whereas the control group did not. The primary outcome was a diagnosis of PPS based on the presence of two or more of the following symptoms or signs occurring at least 72 h postoperatively: fever (temperature >38 degrees C), pericardial or pleural rub, and worsening or recurring anterior pleuritic chest pain. Consequently, PPS developed in 5 (2.8%) of the 177 children: 2.8% (3/106) in the control group and 2.8% (2/71) in the study group (p = 1.00). The secondary outcomes were frequency of other postoperative complications. Postoperative pericardial effusions experienced by 26.7% of the patients were identified more frequently in the treatment group (p < 0.001). Postoperative prophylaxis ASA at a dose of 20 to 50 mg/kg/day for 1 to 6 weeks after surgical closure of ASD does not decrease the incidence of PPS in pediatric patients.

2015 ESC Guidelines for the diagnosis and management of pericardial diseases

“…W toku badań klinicznych przeanalizowano skuteczność różnych strategii zapobiegawczych, w tym podawanie ASA [175], metylprednizonu [176], deksametazonu [177] lub kolchicyny [168,169,172]. Na podstawie wyników czterech badań klinicznych z grupami kontrolnymi dotyczących pierwotnej profilaktyki PPS opracowano systematyczny przegląd obejmujący łącznie 894 pacjentów.…”

Clinical Features Associated With Adverse Events in Patients With Post-Pericardiotomy Syndrome Following Cardiac Surgery

“…The severity of PPS can present as acute or recurrent pericarditis, pericardial effusion with or without tamponade, or constrictive pericarditis with hemodynamic instability requiring surgical intervention (2). Medical treatment consists of nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and in severe cases, oral steroids (3-6). PPS is diagnosed by the presence of at least 2 of the following clinical features: fever in the absence of infectious source; pleuritic chest pain; pericardial friction rub; pleural effusion; and a persistent pericardial effusion one to several weeks after surgery (3).…”

Is possible to prevent the Post-Pericardiotomy Syndrome?

“…Finkelstein Y et al [4] Presence of 2 of the following 5 parameters: fever lasting beyond 1st postoperative week without alternative causes, pleuritic chest pain, friction rub, radiologic evidence of pericardial or pleural involvement, and echocardiographic evidence of a new or enlarged pericardial effusion. Gill PJ et al [12] Presence of 2 or more of the following symptoms/signs occurring at least 72 h postoperatively: fever > 38°C, pericardial or pleural rub, and worsening or recurring anterior pleuritic chest pain. Imazio M et al(COPPS) [5] Presence of at least two of the following criteria: fever lasting beyond the first postoperative week without evidence of systemic or focal infection, pleuritic chest pain, friction rub, evidence of pleural effusion, and evidence of new or worsening pericardial effusion.…”

“…Treatment comparisons were: colchicine vs. placebo (2 RCTs enrolling a total of 471 patients) [4,5], methylprednisolone vs. placebo (a single RCT on 246 pediatric patients) [11], and aspirin vs. historical controls (a single non-randomised study on 177 pediatric patients) [12].…”

“…Anecdotal reports have suggested that colchicine may be useful for the treatment of patients with PPS. Relatively few studies have investigated the possible role of medical therapy to prevent the PPS [4,5,11,12].…”