Treatment and Prophylaxis of Post-pericardiotomy Syndrome in Cardiac Surgery Patients: A Meta-analysis of Main Trials

Abstract Purpose: Post-pericardiotomy syndrome (PPS) is a common complication of cardiac surgery. This study represents a meta-analysis of trials on treatment and prophylaxis of PPS with colchicine, indomethacin and dexamethasone. The primary endpoint was to investigate the efficacy of these drugs, while the secondary endpoints were the efficacy in reducing hospital readmission, cardiac tamponade, symptom persistence, atrial fibrillation as well as their safety and adverse effects. Methods: Literature research was carried out using PubMed. Inclusion criteria were: studies investigating ≥10 patients with clinically PPS in which colchicine, dexamethasone and indomethacin were compared with placebo. We excluded publications referring only to animal experiments or in vitro experiments, studies on < 10 patients, case reports, congress reports, review articles, editorial letters. Results: Among studies with post-operative colchicine treatment, two of them demonstrated a significant reduction of PPS [95% CI -0,86 (-1,96, 0,25)], [95% CI 0,24 (0,03,0,44)]. In the single pre-surgery colchicine administration study, a reduction of PPS was obtained [95% CI -0,55 (-1,04, -0,06)]. In the indomethacin study, pre-surgery administration was linked to a reduction of PPS [95% CI -2,18 (-4,31, -0,06)]. This result was not reported with pre-operative dexamethasone intake [95% CI 0,50 (0,12, 0,88)]. Conclusion: The overall results show a better outcome when colchicine and indomethacin were administered as primary prophylactic agents in order to prevent PPS and PE. Further studies are needed to confirm these results.