Determinants of the postpericardiotomy syndrome : A systematic review

Background Post Pericardiotomy Syndrome (PPS) is a common complication following cardiac surgery, however the exact pathogenesis remains uncertain. Identifying risk factors of PPS might help to better understand the syndrome. The aim of this study was to provide an overview of existing literature around determinants of PPS in adult cardiac surgery patients. Material and methods Two independent investigators performed a systematic search in MEDLINE, EMBASE and the Cochrane Central Register. The search aimed to identify studies published between January 1950 and December 2015, in which determinants of PPS were reported. Results 19 studies met the selection criteria. In these studies, 14 different definitions of PPS were used. The median incidence of PPS was 16%. After quality assessment, 7 studies were considered eligible for this review. Lower preoperative Interleukin-8 levels and higher postoperative complement conversion products where associated with a higher risk of PPS. Among other clinical factors, a lower age, transfusion of red blood cells and lower preoperative platelet and haemoglobin levels were associated with a higher risk of PPS. Colchicine use decreased the risk of PPS. Conclusion We found that both the inflammatory response and perioperative bleeding and coagulation may play a role in the development of PPS, suggesting a multifactorial etiology of the syndrome. Due to a lack of a uniform definition of PPS in the past, study comparability was poor across the studies. This article is protected by copyright. All rights reserved.