Diagnosis and management of the postpericardiotomy syndrome

The present review is aimed at the presentation of recent updates on the diagnosis, management, and prevention of the postpericardiotomy syndrome (PPS) according to more recent publications in the last 24 months. Potentially relevant studies published were searched in BioMedCentral, the Cochrane Collaboration Database of Randomised Trials, ClinicalTrials.gov, EMBASE, Google Scholar, MEDLINE/PubMed, and Scopus. The PPS is a complication of cardiac and thoracic surgery that affects 10% to 40% of patients. The etiopathogenesis is incompletely understood and it is supposed to be immune mediated following pleuropericardial trauma and bleeding. There are no standardized criteria for the diagnosis although a combination of clinical criteria have been proposed in clinical trials for PPS prevention and include fever without alternative causes, pericardial or pleuritic chest pain, pericardial or pleural rubs, and pericardial and/or pleural effusion. Treatment is empiric and based on aspirin, nonsteroidal anti-inflammatory drugs, and/or corticosteroids plus colchicine. Prevention of the PPS has been demonstrated possible and safe with the use of colchicine for 1 month. Although PPS may be responsible for a prolongation of hospital stay and readmissions, the overall prognosis is generally good with low risk of recurrences and cardiac tamponade. The risk of developing constrictive pericarditis has been reported in 2% to 3% of cases in a long-term follow-up. PPS is a common postoperative complication, generally occurring in the first 3 months after surgery. Severe complications are not common, but the syndrome is responsible for hospital stay prolongation and readmissions.