Predictors of pericardial effusion after orthotopic heart transplantation.
OBJECTIVE
Pericardial effusion occurs frequently after orthotopic heart transplantation, but the causes of this complication have not been well described. This study was designed to identify factors predisposing toward the development of significant postoperative pericardial effusions in a large, single-institution population of orthotopic heart transplant recipients.


METHODS
A retrospective review of more than 90 preoperative, intraoperative, and postoperative variables was conducted for 241 patients undergoing orthotopic heart transplantation from September 1988 to December 1999. Patients who had significant postoperative pericardial effusions develop were identified from postoperative echocardiograms by standard criteria. Factors associated with the development of significant pericardial effusions were determined by multivariate logistic regression analysis.


RESULTS
Echocardiographic data were available for 203 of 241 transplant recipients. Forty-two patients (21%) had significant effusions develop. According to multivariate analysis, pericardial effusions were less likely to occur in recipients with a history of previous cardiac surgery (odds ratio 0.13, 95% confidence interval 0.05-0.36, P <.0001) and with greater weight (odds ratio 0.96, 95% confidence interval 0.94-0.99, P <.0048). Pericardial effusions were more likely to occur in patients who had received aminocaproic acid during the operation (odds ratio 5.92, 95% confidence interval 2.23-15.72, P <.0008). Patient survival and hospital length of stay did not differ between patients with and without postoperative pericardial effusions.


CONCLUSIONS
Postoperative pericardial effusions develop in approximately 20% of patients undergoing orthotopic cardiac transplantation. On the basis of the risk factors identified in this study, prevention may prove difficult, although avoidance of the intraoperative use of aminocaproic acid may be helpful.
Quin
Jacquelyn A
JA
Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center at Dallas, Tex 75390, USA.
Tauriainen
M Peter
MP
Huber
Lynne M
LM
McIntire
Donald D
DD
Kaiser
Patricia A
PA
Ring
W Steves
WS
Jessen
Michael E
ME
D000614:Aminocaproates / Q000009:adverse effects; D000933:Antifibrinolytic Agents / Q000009:adverse effects; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology; D016027:Heart Transplantation; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010490:Pericardial Effusion / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome
D000614:Aminocaproates; D000933:Antifibrinolytic Agents