Tomasz Urbanowicz, Ewa Staburzyńska-Migaj, Magdalena Pawłowska, Bartosz Żabicki, Michał Michalak, Marlena Filipiak, Stefan Grajek, Marek Jemielity
Department of Cardiac Surgery and Transplantology, Chair of Cardio-Thoracic Surgery, Poznań University of Medical Sciences, Poznań, Poland
Ann Transplant 2015; 20:193-197
Pericardial effusion is an early complication following orthotopic heart transplantation. Effusion that requires surgical intervention not only prolongs in-hospital stay but also increases early mortality rate. EuroSCORE is one of the most common methods for calculating predictive mortality in heart surgery.
Material and Methods: We performed a retrospective analysis of 25 patients (22 men and 3 women, mean age 49±12 years). Mortality risk by EuroSCORE was estimated prior to surgery. All patients were operated on with Lower-Shumway technique and treated with standard triple immunosuppressive regimen (tacrolimus, mycophenolate mofetil, and prednisolone). They were divided into 2 groups depending on postoperative pericardial effusion that required surgical intervention. There were 9 (36%) patients in the pericardial effusion group (PE group) and 16 (64%) in the control group (C group).
Results: There was 1 death, on the 7th postoperative day, due to Clostridium difficile infection. Mean time of pericardial effusion echocardiographic detection was 9±2 days following surgery. The mean amount of fluid diagnosed in 4-chamber transthoracic echocardiography was 2.2±0.3 cm vs. 0.7±0.2 cm (p<0.05). Pericardial effusion followed thrombocytopenia of 98±17 vs. 172±26×10^9/L in PE and C group (p<0.05).
Patients’ mean intensive care unit time stay was 23±9 days and 11±7 days in PE and C group, respectively (p<0.05). The overall hospitalization time was 38±12 days and 31±23 days in PE and C group, respectively (p<0.05).
The discriminant analysis showed that EuroSCORE >16% is a single predicting variable for postoperative pericardial effusion (AUC 0.946, CI: 0.76–0.99).
Conclusions: Pericardial effusion is a common (36%) complication following heart transplantation. It requires surgical intervention and prolongs intensive care unit stay and overall hospitalization. The discriminant analysis showed that the EuroSCORE >16% is a single predicting variable for postoperative pericardial effusion.
Keywords: Heart Transplantation, Morbidity, Pericardial Effusion, Postoperative Complications, Risk Factors