EuroScore II and Higher Risk for Pericardial Effusion Following Heart Valve Surgery

About 16% of patients have pericardial effusion that requires drainage within 3 months after heart valve surgery, and EuroScore II is significantly associated with an increased risk for significant pericardial effusion during the index admission, according to research published in Open Heart.

The retrospective, observational cohort study included consecutive adult patients (≥18 years) who underwent open heart valve surgery at a tertiary facility in Denmark from August 2013 to November 2017. Demographic and clinical data were obtained from electronic medical records and the Western Denmark Heart Registry.

Significant pericardial effusion was the primary study outcome and was defined as requiring drainage or pericardiocentesis within 3 months of surgery.

A total of 1460 patients (median age 71 years; 70% men) had heart valve surgery and were included. Of the cohort, 62% of participants were diagnosed with aortic valve stenosis, and the median length of stay was 9 days.

In the 3-month follow-up, 230 patients (16%) had a significant pericardial effusion—52% were drained as a subxiphoid approach and 48% as a parasternal/ultrasound-guided approach. For 125 patients (54%), the drainage was done before discharge during the index admission, and for 105 patients (46%) the drainage occurred after discharge.

Adjusted analyses showed that EuroScore II (hazard ratio [HR], 1.05; 95% CI, 1.02-1.08) was significantly associated with an increased risk for significant pericardial effusion during the index admission. Increasing age (HR, 0.97; 95% CI, 0.95-0.98 per year) and concomitant coronary artery bypass grafting (CABG) vs isolated valve surgery (HR, 0.58; 95% CI, 0.35-0.97) were associated with a lower risk for significant pericardial effusion during the index admission.

Male sex (HR, 2.30; 95% CI, 1.32-4.01) and aortic valve disease compared with mitral valve disease (HR, 2.16; 95% CI, 1.20-3.90) were associated with an increased risk for significant pericardial effusion after discharge. Increasing age (HR, 0.95; 95% CI 0.93-0.97), EuroScore II (HR, 0.80; 95% CI, 0.69-0.92), and concomitant CABG vs isolated valve surgery (HR, 0.42; 95% CI, 0.21-0.82) were significantly associated with a decreased risk for significant pericardial effusion after discharge.

Study limitations include the single-center, retrospective design, and that the timing of the removal of pericardial drains could increase the risk for significant pericardial effusions. The study authors also noted that more knowledge on factors associated with outcomes based on prospective designs are needed before drawing a causal conclusion.

“Identifying patients at risk of developing pericardial effusion may help improve postoperative management following heart valve surgery,” the researchers commented.

Reference

Borregaard B, Sibilitz KL, Weiss MG, et al. Occurrence and predictors of pericardial effusion requiring invasive treatment following heart valve surgery. Open Heart. Published online January 21, 2022. doi:10.1136/openhrt-2021-001880