Incidence, predictors and clinical outcome of post-operative cardiac tamponade in patients undergoing heart valve surgery

Abstract

Background: The risk and clinical implication of cardiac tamponade following heart valve surgery are poorly defined in modern era, although cardiac tamponade is potential lethal complication.

Aims: We sought to investigate the incidence, predictors and clinical outcome of cardiac tamponade after valvular heart surgery.

Methods: A total of 556 patients (271 male, mean age 58.5 ± 12.9 years) who underwent heart valve surgery in a single tertiary center between January 2010 and March 2012 were identified. Transthoracic echocardiography was conducted to evaluate cardiac function and hemodynamic changes including the amount of pericardial effusion (PE) and presence of cardiac tamponade in every patient about a week after surgery and repeated regularly after surgery. Patients with suspected pericardial hemorrhage were excluded.

Results: Twenty-four (4.3%) of the 556 patients developed cardiac tamponade in the post-operative period. Among them, 16 (66.7%) and 8 (33.3%) patients underwent percutaneous catheter drainage or pericardial window formation, respectively. The median time of pericardial drainage after surgery was 17 (IQR 13-30) days. There was no difference in age and sex between the group with cardiac tamponade and without. Infective endocarditis as the etiology of valve disease, mechanical valve replacement of aortic or mitral valve and any amount of PE on the first post-operative echocardiography were related with development of cardiac tamponade (all p<0.05). After multivariate adjustment, development of cardiac tamponade was associated with any amount of PE on the echocardiography performed at 5-day after surgery (OR 15.8; p<0.001) and mechanical valve replacement with marginal statistical significance (OR 2.5; p=0.051). Mean hospital days in patients with cardiac tamponade was longer than those without (34.9 vs. 13.5, p=0.031). Re-hospitalization rate of patients after surgery was higher in the group of cardiac tamponade. After resolution of PE after pericardial drainage, there was no echocardiographic recurrence of PE more than small amount during a median of 1044 (IQR 446-1311) days after surgery.

Summary / Conclusion: Cardiac tamponade occurrence after heart valve surgery is uncommon, but it prolongs hospital stay. Presence of any amount of PE at the post-operative 5-day echocardiography and mechanical valve replacement have an independent predictive value for cardiac tamponade. It has benign clinical course without recurrence after timely intervention.