Surgical drainage of late cardiac tamponade following open heart surgery

There are few reports on postoperative late cardiac tamponade with surgical therapy in the literature.

Hospital records of 87 patients with postoperative late cardiac tamponade who had undergone cardiac surgery between January 1999 and December 2003 were evaluated retrospectively.

Out of 8400 patients who had undergone cardiac surgery, 87 patients (1 %) had postoperative late cardiac tamponade. The incidence was 0.1 % for patients with coronary artery bypass grafting and 3.4 % for those with heart valve replacement ( p < 0.01). Subxiphoid midline incision was carried out in 67 patients (77 %). Conversion to re-sternotomy was required in 8 patients due to either ineffective drainage (5 patients, 7.5 %) or laceration and bleeding (3 patients, 4.5 %). Re-sternotomy was undertaken in 20 patients with no complication. Early death occurred in 3 patients with subxiphoid drainage (3.5 %), two of which were related to bleeding. Out of 84 patients who survived, 10 patients had recurrent cardiac tamponade, 5 of which required surgical drainage (6 %).

Bleeding due to dense adhesions between the epicardium and the sternum may be encountered during subxiphoid drainage for postoperative late cardiac tamponade and lead to a 3 % mortality rate.