Evolution of the postoperative pericardial effusion after day 15: the problem of the late tamponade.
OBJECTIVE
To evaluate, through clinical and transthoracic echocardiography (TTE) follow-up, the natural history of persistent pericardial effusion (PE) after postoperative day 15 in patients who were given and were not given anticoagulant therapy.


METHODS
We retrospectively studied a cohort of 1,277 patients who were hospitalized between May 1997 and May 1999 in our center a mean (+/- SD) time period of 15 +/- 3 days after undergoing coronary artery bypass graft (CABG) surgery (856 patients) or valve replacement (VR) surgery (421 patients).


METHODS
TTE was performed on mean (+/- SD) postoperative day 20 +/- 1 (TTE(1)) and postoperative day 30 +/- 2 (TTE(2)). PE severity was classified on a scale from grade 1 to grade 4.


RESULTS
On postoperative day 20 +/- 1, PE was present in 22% of the 1,277 patients and was more frequent after patients underwent CABG surgery than after undergoing VR surgery (25% vs 17%, respectively; p < 0.01). On postoperative day 30 +/- 2, the overall incidence of late tamponade in patients with PE was 4%. The incidence increased with the severity grade of PE at TTE(1) (p < 0.001). The negative predictive value of a severity grade < 2 at TTE(1) for late tamponade was 100%. Late tamponade incidence was higher after VR surgery than after CABG surgery (11% vs 2%, respectively; p < 0.01), and was higher in patients who had received anticoagulation therapy than in those who had not (8% vs 2%, respectively; p < 0.05).


CONCLUSIONS
Persisting PE is common after postoperative day 15 and is more frequent after undergoing CABG surgery than after undergoing VR surgery. The incidence of late tamponade is usually underestimated, and it increases with the presence of VR, anticoagulation therapy, and/or higher postoperative TTE severity grade. Our data suggest that only patients with a PE severity grade of >/= 2 (< 10% of patients) require TTE follow-up after postoperative day 20.
Meurin
Philippe
P
Centre de Réadaptation Cardiaque de la Brie, Villeneuve Saint Denis, France. philippemeurin@hotmail.com
Weber
Hélène
H
Renaud
Nathalie
N
Larrazet
Fabrice
F
Tabet
Jean Yves
JY
Demolis
Pierre
P
Ben Driss
Ahmed
A
D017677:Age Distribution; D000368:Aged; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D017548:Echocardiography, Transesophageal; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011184:Postoperative Period; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D013997:Time Factors