Surgical drainage of late cardiac tamponade following open heart surgery

Abstract

Background: There are few reports on postoperative late cardiac tamponade with surgical therapy in the literature.

Methods: Hospital records of 87 patients with postoperative late cardiac tamponade who had undergone cardiac surgery between January 1999 and December 2003 were evaluated retrospectively.

Results: Out of 8400 patients who had undergone cardiac surgery, 87 patients (1 %) had postoperative late cardiac tamponade. The incidence was 0.1 % for patients with coronary artery bypass grafting and 3.4 % for those with heart valve replacement ( p < 0.01). Subxiphoid midline incision was carried out in 67 patients (77 %). Conversion to re-sternotomy was required in 8 patients due to either ineffective drainage (5 patients, 7.5 %) or laceration and bleeding (3 patients, 4.5 %). Re-sternotomy was undertaken in 20 patients with no complication. Early death occurred in 3 patients with subxiphoid drainage (3.5 %), two of which were related to bleeding. Out of 84 patients who survived, 10 patients had recurrent cardiac tamponade, 5 of which required surgical drainage (6 %).

Conclusions: Bleeding due to dense adhesions between the epicardium and the sternum may be encountered during subxiphoid drainage for postoperative late cardiac tamponade and lead to a 3 % mortality rate.