Predictors of post-pericardiotomy syndrome after native valve-sparing aortic valve surgery

• Published in: PloS one Vol. 19; no. 6; p. e0306306
• Main Authors: Holst, Theresa, Müller, Lisa, Abdelmoteleb, Noureldin, Stock, Sina, Sequeira Gross, Tatiana M, Girdauskas, Evaldas
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 28.06.2024
• Subjects: Adult; Aged; Aorta; Aortic stenosis; Aortic valve; Aortic Valve - surgery; Blood; Blood groups; C-reactive protein; Cardiac arrhythmia; Coronary vessels; Effusion; Female; Heart surgery; Heart valves; Humans; Inflammation; Kinases; Leukocytes; Male; Medical research; Medicine, Experimental; Middle Aged; Nonsteroidal anti-inflammatory drugs; Patients; Pericardiectomy - adverse effects; Pericardiectomy - methods; Pericarditis; Population studies; Postoperative Complications - etiology; Postpericardiotomy Syndrome - etiology; Proteins; Regression analysis; Regression models; Retrospective Studies; Risk Factors; Steroids; Surgery; Ultrasonic imaging; Variables; Veins & arteries
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0306306

We aimed to determine the rate and impact of post-pericardiotomy syndrome after native valve-sparing aortic valve surgery and the perioperative factors associated with its occurrence. All consecutive patients who underwent native valve-sparing aortic valve surgery (i.e., repair ± ascending aorta replacement, valve-sparing root replacement, Ross procedure ± ascending aorta replacement) at our institution between January 2021 and August 2023 served as our study population. Post-pericardiotomy syndrome was diagnosed if patients showed at least two of the following diagnostic criteria: evidence of (I) new/worsening pericardial effusion, or (II) new/worsening pleural effusions, (III) pleuritic chest pain, (IV) fever or (V) elevated inflammatory markers without alternative causes. A logistic regression model was calculated. During the study period, 91 patients underwent native valve-sparing aortic valve surgery. A total of 21 patients (23%) developed post-pericardiotomy syndrome early after surgery (PPS group). The remaining 70 patients (77%) showed no signs of post-pericardiotomy syndrome (non-PPS group). Multivariate logistic regression revealed blood type O (OR: 3.15, 95% CI: 1.06-9.41, p = 0.040), valve-sparing root replacement (OR: 3.12, 95% CI: 1.01-9.59, p = 0.048) and peak C-reactive protein >15 mg/dl within 48 hours postoperatively (OR: 4.27, 95% CI: 1.05-17.29, p = 0.042) as independent risk factors. 73% (8/11) of patients displaying all three risk factors, 60% (9/15) of patients with blood type O and valve-sparing root replacement, 52% (11/21) of patients with blood type O and early postoperative peak C-reactive protein >15 mg/dl and 45% (13/29) of patients with early postoperative peak C-reactive protein >15 mg/dl and valve-sparing root replacement developed post-pericardiotomy syndrome. In summary, blood type O, valve-sparing root replacement and peak C-reactive protein >15 mg/dl within 48 hours postoperatively are significantly associated with post-pericardiotomy syndrome after native valve-sparing aortic valve surgery. Particularly, the presence of all three risk factors is linked to a particularly high risk of post-pericardiotomy syndrome.