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Does pericardial drainage decrease the frequency of postpericardiotomy syndrome?
Insights
Pericardial drainage does not reduce postpericardiotomy syndrome after open-heart surgery. This study found no significant difference in syndrome frequency between anterior mediastinal drainage and combined anterior mediastinal and posterior pericardial drainage.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Research
Background:
- Postpericardiotomy syndrome (PPS) affects 10-40% of patients after open-heart surgery.
- Reportedly, PPS frequency decreases with pericardial drainage.
- The necessity of pericardial drainage for PPS prevention remains debated.
Purpose of the Study:
- To investigate the effect of pericardial drainage on the incidence of postpericardiotomy syndrome.
- To compare anterior mediastinal drainage versus combined mediastinal and pericardial drainage.
Main Methods:
- Randomized controlled trial involving 49 patients undergoing open-heart surgery.
- Group 1: Anterior mediastinal drainage only.
- Group 2: Anterior mediastinal and posterior pericardial drainage.
Main Results:
- No significant difference in PPS frequency between the two drainage groups.
- Similar rates of fever, thoracic pain, arthralgia, and inflammatory markers.
- No cases of cardiac tamponade observed.
Conclusions:
- Pericardial drainage does not appear to influence the frequency of postpericardiotomy syndrome.
- The study suggests pericardial drainage may be unnecessary after open-heart surgery.
Abstract:
The postpericardiotomy syndrome occurs in 10% to 40% of patients who undergo open-heart surgery. Its frequency is reportedly decreased when pericardial drainage is used. To challenge this, 50 consecutive patients (1 was disqualified) were randomly assigned to two groups: one in which only the anterior mediastinum was drained (group 1) and the other in which the anterior mediastinum and posterior pericardium were drained (group 2). The surgical procedures performed were: coronary artery bypass grafting in 14 patients, valve surgery in 23 and repair of congenital defects in 12. The two groups were similar with respect to age and the volume of blood drained. Significant differences were found only for the duration of bypass and volume of blood given. At 7 to 10 days there were no differences in the frequency of fever, thoracic pain or presence of arthralgia. Findings were similar in both groups for leukocyte count, sedimentation rate, serum lactic dehydrogenase value and for the frequency of positive blood, urine and sputum cultures. Six patients (three in each group) had a postpericardiotomy syndrome that required steroid treatment and prolonged hospitalization for 10 more days. However, none had postpericardiotomy syndrome complicating coronary artery bypass surgery. None of the patients had cardiac tamponade. This study demonstrates that pericardial drainage has no effect on the frequency of postpericardiotomy syndrome and appears to be unnecessary after open-heart surgery.