University of Oulu

Lehto, J., Gunn, J., Björn, R., Malmberg, M., Airaksinen, K. E. J., Kytö, V., Nieminen, T., Hartikainen, J. E. K., Biancari, F., & Kiviniemi, T. O. (2020). Adverse events and survival with postpericardiotomy syndrome after surgical aortic valve replacement. The Journal of Thoracic and Cardiovascular Surgery, 160(6), 1446–1456.

Adverse events and survival with postpericardiotomy syndrome after surgical aortic valve replacement

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Author: Lehto, Joonas1; Gunn, Jarmo1; Björn, Rikhard1;
Organizations: 1Heart Center, Turku University Hospital and University of Turku, Turku, Finland
2Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
3Department of Internal Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
4Department of Internal Medicine, South Karelia Central Hospital, Lappeenranta, Finland
5Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
6Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
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Language: English
Published: Elsevier, 2020
Publish Date: 2020-12-08


Objectives: Postpericardiotomy syndrome (PPS) is a relatively common complication after cardiac surgery. However, long-term follow-up data on the adverse events and mortality of PPS patients requiring invasive interventions are scarce.

Methods: We sought to assess the occurrence of mortality, new-onset atrial fibrillation (AF), cerebrovascular events, and major bleeds in PPS patients requiring medical attention in a combination database of 671 patients who underwent isolated surgical aortic valve replacement with a bioprosthesis (n = 361) or mechanical prosthesis (n = 310) between 2002 and 2014 (Cardiovascular Research Consortium—A Prospective Project to Identify Biomarkers of Morbidity and Mortality in Cardiovascular Interventional Patients [CAREBANK] 2016‐2018). PPS was defined as moderate if it resulted in delayed hospital discharge, readmission, or medical therapy because of the symptoms; and severe if it required interventions for the evacuation of pleural or pericardial effusion.

Results: The overall incidence of PPS was 11.2%. Median time to diagnosis was 16 (interquartile range, 11‐36) days. Severe PPS was diagnosed in 3.6% of patients. Severe PPS seemed to be associated with higher mortality (hazard ratio, 2.01; 95% confidence interval, 1.03‐3.91; P = .040). Moderate or severe PPS increased the risk of new-onset AF during the early postoperative period (hazard ratio, 1.72; 95% confidence interval, 1.12‐2.63; P = .012). No significant associations were found between PPS and cerebrovascular events or major bleeds during the follow-up.

Conclusions: Patients with PPS requiring invasive interventions are at increased risk for mortality unlike those with mild to moderate forms of the disease. PPS requiring medical attention is associated with a higher AF rate during the early post-operative period but has no significant effect on the occurrence of major stroke, stroke or transient ischemic attack, or major bleeds during long-term follow-up.

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Series: Journal of thoracic and cardiovascular surgery
ISSN: 0022-5223
ISSN-E: 1097-685X
ISSN-L: 0022-5223
Volume: 160
Issue: 6
Pages: 1446 - 1456
DOI: 10.1016/j.jtcvs.2019.12.114
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: Copyright © 2020 by The American Association for Thoracic Surgery. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://