Postpericardiotomy syndrome: a clinical review

Abstract

Postpericardiotomy syndrome is considered a frequent complication in a subgroup of patients who undergo cardiac surgery. It is characterized by a pleuropericardial inflammatory response triggered by mechanical mesothelial damage secondary to a surgical procedure and an autoimmune component possibly implicated in its pathogenesis. Low concentrations of interleukin 8 and high of complement conversion products (C3bi and C3), in addition to low hemoglobin concentrations and a lower platelet count prior to surgery, as well as postsurgical transfusion of red blood cells, have been described as risk factors for this syndrome. The use of colchicine and medical treatment for diabetes are considered protective factors. Maintaining a high index of suspicion is essential, considering the factors related to the patient and the surgical procedure that are associated with an increased risk of developing postpericardiotomy syndrome, the individual characteristics of the patient and the variability of the clinical presentation in order to establish a timely diagnosis in addition to carry out an adequate risk stratification and thus define the optimal treatment strategy. The current European clinical practice guidelines propose a therapeutic scheme for the management of postpericardiotomy syndrome identical to that of acute pericarditis, whose main pillar is anti-inflammatory therapy with the aim of accelerating the remission of symptoms and reducing recurrences. Colchicine is the only therapeutic agent that has been shown to be safe and effective for primary prevention of postpericardiotomy syndrome, so current evidence recommends its prescription for 1 month in weight-adjusted doses similar to those used for acute pericarditis.