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Risk of Clinically Relevant Pericardial Effusion After Pediatric Cardiac Surgery
Rik Adrichem1, Saskia Le Cessie2,3, Mark G Hazekamp4
1Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, PO Box 9600, 2300RC, Leiden, The Netherlands.
Insights
Clinically relevant pericardial effusion (PE) complicates 11% of pediatric cardiac surgeries. Risk factors include age, bypass use, and right-sided heart defects, while prior surgery reduces risk.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Critical Care Medicine
Background:
- Pericardial effusion (PE) is a common complication following pediatric cardiac surgery.
- A lack of standardized classification for PE severity hinders clinical management.
- Defining clinically relevant PE is crucial for understanding its impact.
Purpose of the Study:
- To evaluate pericardial effusion that alters clinical management (clinically relevant PE) after pediatric cardiac surgery.
- To identify risk factors associated with the development of clinically relevant PE.
- To confirm previously identified risk factors and discover new ones.
Main Methods:
- A retrospective analysis of 1241 surgical episodes in 1031 pediatric patients.
- Patients were followed for one month post-surgery.
- Multivariate analysis combined preoperative, perioperative, and postoperative data, using a 1:1 case-control matching for patients with and without clinically relevant PE.
Main Results:
- Clinically relevant PE occurred in 11.0% of postoperative periods.
- Identified risk factors included: age, body surface area (BSA), right-sided heart defects, cardiopulmonary bypass use, postoperative CPAP duration, and inotropic score.
- A history of previous operation was identified as a risk reducer.
Conclusions:
- Approximately 11% of pediatric cardiac surgery patients develop clinically relevant PE requiring treatment changes.
- Cardiopulmonary bypass use and right-sided heart defects are newly identified risk factors for clinically relevant PE.
- Established risk factors like age, BSA, CPAP duration, and inotropic score were confirmed, alongside a protective factor of prior surgery.
Abstract:
Pericardial effusion (PE) after pediatric cardiac surgery is common. Because of the lack of a uniform classification of the presence and severity of PE, we evaluated PE altering clinical management: clinically relevant PE. Risk factors for clinically relevant PE were studied. After cardiac surgery, children were followed until 1 month after surgery. Preoperative variables were studied in the complete cohort. Perioperative and postoperative variables were studied in a case-control manner. Patients with and without clinically relevant PE were matched on age, gender, and diagnosis severity in a 1:1 ratio. Multivariate analysis was conducted using important preoperative variables from the complete cohort combined with perioperative and postoperative variables from the case-control data. 1241 surgical episodes in 1031 patients were included. Clinically relevant PE developed in 136 episodes (11.0%). Multivariate correlation with the outcome was present for age, BSA (adjusted odds ratio: 1.6, 95% CI 0.9-2.8), right-sided heart defect (adjusted odds ratio: 1.3, 95% CI 0.9-1.9), history of previous operation (adjusted odds ratio: 0.5, 95% CI 0.3-0.7), cardiopulmonary bypass use (adjusted odds ratio: 2.1, 95% CI 0.9-4.5), duration of CPAP postoperatively, and an inotropic score (adjusted odds ratio: 1.01, 95% CI 0.998-1.03). In this large patient cohort, 11.0% of postoperative periods of pediatric cardiac surgery were complicated by PE requiring alteration of treatment. Secondly, we newly identified cardiopulmonary bypass use and right-sided heart defects as risk factors for clinically relevant PE and confirmed previously described risk factors: age, CPAP duration, BSA, and inotropic score and a previously described risk reductor: history of previous operation.
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