Postoperative laboratory values.

BackgroundWe aimed to determine the rate and impact of post-pericardiotomy syndrome after native valve-sparing aortic valve surgery and the perioperative factors associated with its occurrence.MethodsAll consecutive patients who underwent native valve-sparing aortic valve surgery (i.e., repair ± ascending aorta replacement, valve-sparing root replacement, Ross procedure ± ascending aorta replacement) at our institution between January 2021 and August 2023 served as our study population. Post-pericardiotomy syndrome was diagnosed if patients showed at least two of the following diagnostic criteria: evidence of (I) new/worsening pericardial effusion, or (II) new/worsening pleural effusions, (III) pleuritic chest pain, (IV) fever or (V) elevated inflammatory markers without alternative causes. A logistic regression model was calculated.ResultsDuring the study period, 91 patients underwent native valve-sparing aortic valve surgery. A total of 21 patients (23%) developed post-pericardiotomy syndrome early after surgery (PPS group). The remaining 70 patients (77%) showed no signs of post-pericardiotomy syndrome (non-PPS group). Multivariate logistic regression revealed blood type O (OR: 3.15, 95% CI: 1.06–9.41, p = 0.040), valve-sparing root replacement (OR: 3.12, 95% CI: 1.01–9.59, p = 0.048) and peak C-reactive protein >15 mg/dl within 48 hours postoperatively (OR: 4.27, 95% CI: 1.05–17.29, p = 0.042) as independent risk factors. 73% (8/11) of patients displaying all three risk factors, 60% (9/15) of patients with blood type O and valve-sparing root replacement, 52% (11/21) of patients with blood type O and early postoperative peak C-reactive protein >15 mg/dl and 45% (13/29) of patients with early postoperative peak C-reactive protein >15 mg/dl and valve-sparing root replacement developed post-pericardiotomy syndrome.ConclusionIn summary, blood type O, valve-sparing root replacement and peak C-reactive protein >15 mg/dl within 48 hours postoperatively are significantly associated with post-pericardiotomy syndrome after native valve-sparing aortic valve surgery. Particularly, the presence of all three risk factors is linked to a particularly high risk of post-pericardiotomy syndrome.

**背景** 本研究旨在明确自体瓣膜保留主动脉瓣术后心包切开术后综合征（post-pericardiotomy syndrome）的发生率、影响，以及与其发生相关的围手术期危险因素。
**方法** 本研究纳入2021年1月至2023年8月于本机构接受自体瓣膜保留主动脉瓣手术（即主动脉瓣修复±升主动脉置换、瓣膜保留根部置换、罗斯手术（Ross procedure）±升主动脉置换）的所有连续性患者作为研究队列。心包切开术后综合征的诊断标准为患者满足以下至少2项：(I) 新发或加重的心包积液，或(II) 新发或加重的胸腔积液，(III) 胸膜炎性胸痛，(IV) 发热，或(V) 炎症标志物升高且无其他明确诱因。本研究采用Logistic回归模型进行统计分析。
**结果** 研究期间，共计91例患者接受了自体瓣膜保留主动脉瓣手术。其中21例（23%）于术后早期发生心包切开术后综合征，纳入PPS组；剩余70例（77%）未出现该综合征，纳入非PPS组。多因素Logistic回归分析显示，O型血（比值比[OR]=3.15，95%置信区间[CI]=1.06~9.41，P=0.040）、瓣膜保留根部置换术（OR=3.12，95%CI=1.01~9.59，P=0.048）以及术后48小时内C反应蛋白峰值＞15mg/dl（OR=4.27，95%CI=1.05~17.29，P=0.042）为独立危险因素。同时具备全部3项危险因素的患者中，73%（8/11）发生心包切开术后综合征；仅合并O型血与瓣膜保留根部置换术的患者中，60%（9/15）发病；仅合并O型血与术后早期C反应蛋白峰值＞15mg/dl的患者中，52%（11/21）发病；仅合并术后早期C反应蛋白峰值＞15mg/dl与瓣膜保留根部置换术的患者中，45%（13/29）发病。
**结论** 综上，O型血、瓣膜保留根部置换术以及术后48小时内C反应蛋白峰值＞15mg/dl，与自体瓣膜保留主动脉瓣术后心包切开术后综合征显著相关；其中同时具备全部3项危险因素的患者，发生该综合征的风险尤其高。