Preventing Postcardiotomy Syndrome After Cardiac Surgery
Postcardiotomy syndrome — encompassing post-pericardiotomy syndrome and associated pericardial or pleural effusion — is a recognised complication of cardiac surgery. A perioperative prophylactic strategy is central to reducing its incidence and the complications that follow.
Clinical approach
Anti-inflammatory prophylaxis is initiated around the time of cardiac surgery. The protocol specifies which agents to use, when treatment should begin relative to surgery, and how long it should continue — details available in the full regimen below.
Treatment goals
- Reduction or absence of post-pericardiotomy syndrome
- Prevention of pericardial effusion
- Prevention of pleural effusion
- Prevention of cardiac tamponade
- Absence of atrial fibrillation at 72 hours post-operatively
References
DOI: 10.1007/s10557-021-07261-4
- The weight-adjusted colchicine dosage was 0.5 mg/kg in three studies and 1 mg daily in two studies.
- The duration of colchicine treatment was between 14 and 30 days.
- Indomethacin dosage was 25 mg 3 times/day for three days before surgery in one trial.
- Treatment duration lasted for 6 weeks after the surgery.
- Given their low adverse effects rates, clinical administration of colchicine and indomethacin in the preoperative setting could be considered an optimal solution to prevent PPS and PE.
- The authors' conclusions indicated indomethacin as an alternative to other drugs to avoid postoperative PE.
- Primary endpoints were related to registering the reduction of pericardial and pleural effusion in all the studies examined, while there was no homogeneity with secondary endpoints in the study groups.
- The secondary endpoints were to assess the effectiveness of the three drugs in reducing hospital readmission, cardiac tamponade, symptom persistence, and atrial fibrillation after 72 h, as well as the safety and adverse effects of pharmacological treatment.