LATE CARDIAC-TAMPONADE AFTER OPEN-HEART-SURGERY

Late cardiac tamponade occurred in 74 patients 5-287 (median 16) days after open-heart surgery and was treated with pericardiocentesis or surgery. The overall incidence of late cardiac tamponade was 1.3%. After valve operations it was 2.6% and after isolated coronary surgery 0.7% (53/2028 vs. 18/2661, p < 0.002). The diagnosis was assessed by echocardiography in 93% of cases. Pericardiocentesis, attempted in 65 cases (88%), was curative in 80% but failed in 20%. Eight of the latter 13 underwent emergency surgery and five were medically treated. Failure of pericardiocentesis was associated with posterior location of fluid, clots, echo-free space < 20 mm or myocardial insufficiency. The subxiphoid part of the wound was surgically re-entered in ten cases and the entire sternotomy in seven. Four patients (5%) died within 30 days of the primary intervention. All hospital survivors were observed for a median of 44 (range 11-115) months. Three (4%) had recurrent pericardial effusion requiring repeat pericardiocentesis, but none had pericardial constriction. The 5-year survival rate was 73%.