Postoperative Pericarditis After Cardiac Surgery in Adult Congenital Heart Disease

Cardiac surgery is associated with postsurgical inflammatory conditions, including postoperative pericarditis, that confer morbidity and are understudied in the adult congenital heart disease (ACHD) population.

The purpose of this study was to evaluate the incidence and risk factors for developing postoperative pericarditis in ACHD surgical operations.

Retrospective study of ACHD patients who underwent cardiac surgery between 2015 and 2023 at a major New York medical center. Pericarditis diagnosis required: 1) no prior history of pericarditis; 2) at least 2/4 criteria for acute pericarditis (chest pain, friction rub, nonlocalizing ST-segment elevations or PR depressions, new/worsening pericardial effusion); and 3) treatment of pericarditis (nonsteroidal anti-inflammatory drugs, colchicine, steroids, interleukin 1 inhibition). Surgical data and patient characteristics were collected. Logistic regression was used to determine baseline variables associated with pericarditis after atrial septal defect (ASD) repair.

Among 214 ACHD patients undergoing cardiac surgery (median age 36 years [Q1-Q3: 26-53 years], 48.5% male), 47 patients (22.0%) developed postoperative pericarditis and were more commonly Asian or Black. The majority (37/47, 78.7%) of cases occurred within the first 7 days, with clinical resolution within 2 to 4 weeks, except for 4 patients (8.5%) who developed recurrent pericarditis. None developed tamponade or required pericardial drainage. Pericarditis occurred most frequently with shunt repair operations (27/47, 57.4%), in particular after ASD repair (24/29, 82.7%) using autologous pericardium (15/33, 45.4%) and aortic valve replacements (10/29, 34.4%). Logistic regression analysis of ASD repairs identified younger age, male sex, and Asian race as independent risk factors for pericarditis.

Roughly one in five ACHD cardiac surgical cases develop postoperative pericarditis, most frequently after ASD repairs using autologous pericardium or aortic valve replacement, yet only rarely had long-lasting complications.