The post-pericardiotomy syndrome

The postpericardiotomy syndrome (PPS) is a relatively common complication following cardiac surgery, whose epidemiology is not well known because there are no standardized definitions. The aim of the present study is to review more recent updates on the diagnosis, therapy, prognosis, and especially prevention of the PPS.

Recent studies suggest that it is time to develop standardized criteria for the diagnosis of the PPS to allow early recognition and treatment. Limited knowledge is still available on the pathogenesis of the syndrome, but it is now clear that the presumptive immune-mediated origin is not able to explain all cases. Treatment is largely empirical and based on antiinflammatory drugs either nonsteroidal or corticosteroids with the possible adjunct of colchicine, that has been demonstrated as a promising well tolerated and efficacious means to prevent several postoperative complications, including the PPS, pericardial and pleural effusions, and atrial fibrillation.

Contemporary series of the PPS are scarce. About 20% of patients are affected by the syndrome after cardiac surgery with a significant increase in hospital stay, readmissions, and management costs. The overall short-term and middle-term prognosis is relatively good but constriction may develop in a long-term follow-up in a minority of patients. Therapeutic and preventive strategies, especially based on the use of colchicine, are worthy of further investigations to develop a more evidence-based approach to treatment and prevention.