Late cardiac tamponade after open heart surgery: incidence, role of anticoagulants in its pathogenesis and its relationship to the postpericardiotomy syndrome.

SUMMARY Cardiac tamponade that occurs late after cardiac surgery (7 days) is relatively uncommon but potentially fatal. We analyzed its incidence, clinical course and relationship to the postpericardiotomy syndrome in 1290 consecutive adult patients who survived surgery. Criteria for diagnosis of cardiac tamponade were (1) elevated jugular venous pressure, (2) hypotension or decreased cardiac index, (3) characteristic hemo-dynamics at cardiac catheterization, and (4) echocardiographic evidence of pericardial effusion. Ten of the 1290 patients (0.8%) developed cardiac tamponade. Surgery was for congenital heart disease in five patients, valvular heart disease in two patients, and coronary artery disease in three patients. The onset of hemodynamic compromise ranged from 15-180 days postoperatively (mean 49 days). All patients had echo-cardiographic evidence of pericardial fluid, eight had a pericardial friction rub at the time of cardiac tam-ponade, nine had pericardial pain, and all were considered to have a postpericardiotomy syndrome. One patient was receiving coumadin and two patients were receiving aspirin before the diagnosis of cardiac tamponade. Nine patients underwent pericardiocentesis (0.5-1 1 of fluid). There were no deaths in the group. The syndrome resolved in nine patients with conservative medical therapy and one patient required pericardial stripping for recurrent cardiac tamponade. In this study, cardiac tamponade occurred in 0.8% of patients who survived cardiac surgery; cardiac tam-ponade occurred in patients without prior anticoagulation, in marked contrast to previously reported cases; pericardiocentesis and conservative medical therapy were successful in treating the majority of patients; clear symptoms and signs of pericardial involvement were present before cardiac tamponade occurred. CARDIAC TAMPONADE after cardiac surgery is one of many late complications that cause postopera-tive morbidity and mortality. The incidence of this entity ranges from 0.1-6% in reported series and is considered to be uniformly associated with postoperative anticoagulation, usually in patients undergoing valve replacement.'-5 The postpericardiotomy syndrome is characterized by persistence or appearance of fever after the first postoperative week and signs of peri-cardial, and often pleural, reactions, and has been reported in 20-30% of patients who undergo cardiac surgery.6`8 We attempted to define the incidence of late cardiac tamponade, the role of anticoagulants in its patho-genesis, and its relationship to the postpericardi-otomy syndrome in 1290 consecutive patients who underwent open heart surgery at Yale-New Haven Methods We analyzed the medical history and clinical course of 1290 consecutive patients who survived cardiac surgery at Yale-New Haven Hospital from 1973-1978. The pericardium was left open in all 942 patients …