Pericardiectomy for Constrictive Pericarditis: A Clinical, Echocardiographic, and Hemodynamic Evaluation of Two Surgical Techniques (original) (raw)
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The Annals of Thoracic Surgery, 2015
Objective: Pericardiectomy is associated with a high prevalence of morbidity and mortality. We evaluated the predictors of in-hospital complications and outcome for pericardiectomy procedure for patients with constrictive pericarditis (CP) in a single-center in China. Methods: One-hundred sixty-five patients who underwent pericardiectomy for CP between January 1990 and December 2012 at our hospital were evaluated. Results: The mean age of the study cohort was 36.79 ± 18.52 years. The approach was through a median sternotomy in 91.5% of patients. Cardiopulmonary bypass was used in 14.5% (24/165 patients). Unadjusted rates of mortality and complication were approximately 5.4% and 23%, respectively. The main cause of death was severe low cardiac output syndrome. Major complications were postoperative low cardiac output syndrome, reoperation for bleeding, pneumonia, mediastinitis, chylothorax and cerebral infarction. One-year survival was 92%. One-year follow-up revealed that New York Heart Association functional class III or IV, age, intraoperative use of cardiac pulmonary bypass and hemodialysis were associated with increased mortality and morbidity. Conclusions: Total pericardiectomy is associated with lower perioperative and late mortality, and the extent of pericardial resection should be decided according to individual conditions. Perioperative management and complete release of the thickened pericardium of the left ventricle should prevent postoperative complications.
Polish Journal of Cardio-Thoracic Surgery
Introduction: Constrictive pericarditis (CP) usually presents as a result of chronic fibrous pericardial thickening and calcification of the pericardium which causes reduced cardiac output. Despite the lack of prospective studies comparing the different therapeutic strategies, surgical pericardiectomy is a valuable treatment under most circumstances. Aim: We analyzed our records to highlight the predictors of morbidity and mortality of pericardiectomy and also short-term surgical outcome of the same procedure in a single center. Material and methods: We carried out a comprehensive retrospective analysis of the records of patients who underwent surgery for CP at our institute between 2013 and 2018. 30 patients underwent isolated pericardiectomy. All patients underwent median sternotomy and total pericardiectomy without the use of cardiopulmonary bypass. Pre-operative, intra-operative and post-operative characteristics were noted. Results: Fifteen patients had a history of pulmonary tuberculosis. The majority of the patients presented with NYHA grade III or IV. 60% of the patients were male. The preoperative mean central venous pressure was 24 ±9 mm Hg and decreased to 9 ±5 mm Hg after surgery. The 30-day mortality was 6.66% (2/30). Morbidity was mainly due to low-cardiac output syndrome (n = 4). A total of 26 patients had significant improvement in their NYHA status. Conclusions: Although pericardiectomy for CP remains associated with some operative mortality, the short-term outcome is favorable, and surgical treatment is able to improve the functional class in the majority of survivors.
Subtotal Pericardiectomy via Sternotomy for Constrictive Pericarditis
Asian Cardiovascular and Thoracic Annals, 2000
Records of 103 patients with constrictive pericarditis who underwent subtotal pericardiectomy from January 1990 to December 1997 were retrospectively analyzed. The etiology of pericardial constriction was unknown in 63, tuberculous in 30, pyogenic in 7, and miscellaneous in 3 patients. Adequate pericardiectomy could be accomplished in 85 (82.5%) patients. Eleven patients (10.68%) died within 30 days of surgery. The 92 survivors were followed up for 47.21 ± 30.7 months; functional status improved in all cases. Of 15 variables examined by univariate logistic regression analysis, preoperative New York Heart Association functional class IV, atrial fibrillation, left atrial size > 40 mm·m -2 , mild to moderate mitral regurgitation, tricuspid regurgitation, pericardial calcification, and inadequate pericardiectomy were found to be significant predictors of poor outcome. Adequate pericardiectomy via sternotomy was considered to carry low operative risk and provide excellent improvement in functional capacity.
Outcome of Pericardiectomy for Constrictive Pericarditis: Single Center Experience
International Journal of Cardiovascular and Thoracic Surgery
Background. Constrictive pericarditis is a rare chronic inflammatory disease that impairs diastolic filling, reduces cardiac output, and ultimately leads to heart failure. TB and post-pericardiotomy and idiopathic are the commonest causes. Multimodality imaging are essential for confirming the diagnosis Trans-thoracic echocardiography is the golden method of diagnosis. Computed tomography is another confirmatory diagnostic tool of pericardial thickness. Right side heart Cath and magnetic resonance imaging help in diagnosis of constrictive pericarditis from restrictive cardiomyopathy and confirm diastolic filling dysfunction of the heart. Pericardiectomy is the mainstay therapy, should be early and complete if feasible to provide symptoms relieve and adequate outcome Patients and methods. We retrospectively review medical records of 13 patients operated for pericardiectomy for constrictive pericarditis. Demographic and perioperative data were analyzed. Results. The mean age of patients was 49.9±7.8 years. All of our patients were symptomatic (NYHA class II-IV) with 7 months median duration of symptoms. TB was the commonest cause. Complete pericardiectomy was achieved in 11 patients (84.6%). Cardiopulmonary bypass was conducted in 5 patients (4 for associated cardiac procedure and one for repair of IVC injury). NYHA class improved to class I in 9 patients (75%). We had one case (7.6%) of mortality. The cause of death was sepsis and respiratory failure. Conclusion. Phrenic to phrenic pericardiectomy without bypass is safe and effective for treating constrictive pericarditis.
Constrictive pericarditis treated by surgery
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2012
We reviewed the records of 45 patients (mean age, 46.6 ± 14.9 yr; range, 21-84 yr) with a diagnosis of constrictive pericarditis who had undergone pericardiectomy from 1994 through 2006. Preoperatively, 2 of the patients (4.4%) were in New York Heart Association (NYHA) functional class I, 20 (44.4%) in class II, 22 (48.9%) in class III, and 1 (2.2%) in class IV. Pericardial calcification was detected in 20% of plain chest radiographs. Constrictive pericarditis was caused by tuberculosis in 22.2%, chronic renal failure in 8.9%, a history of sternotomy in 4.4%, and malignancy in 4.4%. The cause was idiopathic in 60% of the patients. Low-output state was the most common postoperative problem (22.2%). The mean follow-up period was 40 ± 18 months (range, 3-144 mo). Three months postoperatively, only 1 of 43 available patients (2.3%) was in NYHA class III, while the rest were in class I (36 patients; 83.7%) or II (6 patients; 14%). The overall mortality rate was 4.4%: 1 patient with tuber...
Surgical management of constrictive pericarditis
Ghana Medical Journal, 2010
Background: Constrictive pericarditis is a disease characterized by marked thickening and dense scarring of the pericardium with pericardial sac obliteration, or calcification of the pericardium. Without treatment this disease is characterized by high morbidity and mortality. Objective: To review the surgical management of constructive pericarditis and the post operative challenges. Methods: Eleven patients who had pericardiectomy for constructive pericarditis between 2000 and 2005 were studied. Data was obtained from the operating theatre register, histopathological reports and patient's case notes. Results: The mean age was 33 years with a range of 14 to 53 years. There were seven males (63.6%) and four females (36.4%). Seven (63.6%) out of the eleven patients operated were treated for pulmonary tuberculosis. The cause of pericardial constriction in four patients (36.4%) was undetermined. Follow up period was between 4-59 months. The mean follow up was 17.5 months. Seven patients (63.6%) were off diuretics and had no exercise intolerance. Patients were classified using the New York Heart Association (NYHA) n (NYHA) functional and therapeutic classification in class I-V. Two patients preoperatively in class III are now in class I after surgery on low dose diuretics. One patient who had calcific constrictive pericarditis and came in class III was now in class II with diuretics after 3 years of follow up. There was no postoperative mortality. One patient was lost to follow up. Conclusion: Pericardiectomy is a useful procedure for constrictive pericarditis and was beneficial to all the patients in this study with an improvement in their functional capacity. Intensive peri-operative monitoring and management reduced morbidity and mortality.
Long-term outcomes of pericardiectomy for constrictive pericarditis
Journal of Cardiothoracic Surgery, 2015
Background: Constrictive pericarditis is a rare and disabling disease that can result in chronic fibrous thickening of the pericardium. The purpose of this study was to evaluate the long-term outcomes following treatment of constrictive pericarditis by pericardiectomy. Methods: Between September 1992 and May 2014, 47 patients who underwent pericardiectomy for constrictive pericarditis were retrospectively examined. Demographic, pre-, intra-and postoperative data and long-term outcomes were analyzed. Results: Thirty of the patients were male, the mean age was 45.8 ± 16.7. Aetiology of constrictive pericarditis was tuberculosis in 22 (46.8 %) patients, idiopathic in 15 (31.9 %), malignancy in 3 (6.4 %), prior cardiac surgery in 2 (4.3 %), non-tuberculosis bacterial infections in 2 (4.3 %), radiotherapy in 1 (2.1 %), uraemia in 1 (2.1 %) and posttraumatic in 1 (2.1 %). The surgical approach was achieved via a median sternotomy in all patients except only 1 patient. The mean operative time was 156.4 ± 45.7 min. Improvement in functional status in 80 % of patients' at least one New York Heart Association (NYHA) functional class was observed. In-hospital mortality rate was 2.1 % (1 of 47 patients). The cause of death was pneumonia leading to progressive respiratory failure. The late mortality rate was 23.4 % (11 of 47 patients). The mean follow-up time was 61.2 ± 66 months. The actuarial survival rates were 91 %, 85 % and 81 % at 1, 5 and 10 years, respectively. Recurrence requiring a repeat pericardiectomy was developed in no patient during follow-up. Conclusion: Pericardiectomy is associated with high morbidity and mortality rates. Cases with neoplastic diseases, diminished cardiac output, cases in need of reoperation are expected to have high mortality rates and less chance of functional recovery.
Surgical Treatment of Constrictive Pericarditis: a Single-Center Experience
Koşuyolu heart journal, 2019
Introduction: Constrictive pericarditis (CP) is a rare and potentially lethal disease. It is one of the important reasons of the right-sided heart failure, and it requires immediate intervention. The aim of this study was to investigate the short-term and mid-term results in patients who were operated for CP in our hospital center. Patients and Methods: We evaluated data of 27 patients who underwent pericardiectomy due to CP in our center. Clinical findings, results of imaging modalities, the surgical technique, and the follow-up were retrospectively evaluated. Results: The mean age of our patients was 49.78 years. The most common symptom was dyspnea. Peripheral edema was the most common sign during the physical examination. The mean pericardium thickness ranged between 3.4 mm and 6.6 mm in diameter. Total pericardiectomy was performed in 15 patients (55.6%), while partial pericardiectomy was performed in 12 patients (44.4%). Pericardiectomy with concomitant cardiac surgery was performed in 5 patients (18.5%). Unfortunately, postoperative mortality occurred in 4 patients (14.8%). Conclusion: Surgical removal of pericardium is a treatment modality that should be preferred in patients with CP, despite high mortality rates reported in some series.
Surgical Treatment of Constrictive Pericarditis
Brazilian Journal of Cardiovascular Surgery
Introduction: The mainstay of the treatment of constrictive pericarditis is pericardiectomy. However, surgery is associated with high early morbidity and mortality and low long-term survival. The aim of this study is to describe our series of pericardiectomies performed over 30 years. Methods: A descriptive, observational, and retrospective analysis of all pericardiectomies performed at the Institute of Cardiology and Cardiovascular Surgery of the Favaloro Foundation was performed. Results: A total of 45 patients underwent pericardiectomy between June 1992 and June 2022, mean age was 52 years (standard deviation ± 13.9 years), and 73.3% were men. Idiopathic constrictive pericarditis was the most prevalent (46.6%). The variables significantly associated with prolonged hospitalization were preoperative advanced functional class (incidence of 38.4%, P<0.04), persistent pleural effusion (incidence of 81.8%, P<0.01), and although there was no statistical significance with the use of cardiopulmonary bypass, a trend in this association is evident (P<0.07). We found that 100% of the patients with an onset of symptoms greater than six months had a prolonged hospital stay. In-hospital mortality was 6.6%, and 30-day mortality was 8.8%. The preserved functional class is 17 times more likely to improve their symptomatology after pericardiectomy (odds ratio 17, 95% confidence interval 2.66-71; P<0.05). Conclusion: Advanced functional class at the time of pericardiectomy is the variable most strongly associated with mortality and prolonged hospitalization. Onset of the symptoms greater than six months is also a poor prognostic factor mainly associated with prolonged hospitalization; based on these data, we strongly support the recommendation of early intervention.
Experience With Pericardiectomy for Constrictive Pericarditis Over Eight Decades
The Annals of thoracic surgery, 2017
The purpose of this study was to review the surgical outcomes of pericardiectomy for constrictive pericarditis and to examine risk factors for overall mortality in a contemporary period. We reviewed all patients who underwent pericardiectomy for constriction from 1936 through 2013. The investigation included constrictive pericarditis cases confirmed intraoperatively, all other types of pericarditis were excluded; 1,071 pericardiectomies were performed in 1,066 individual patients. Patients were divided into two intervals: a historical (pre-1990) group (n = 259) and a contemporary (1990-2013) group (n = 807). Patients in the contemporary group were older (61 versus 49 years; p < 0.001), more symptomatic (NYHA class III or IV in 79.6% versus 71.2%; p < 0.001), and more frequently underwent concomitant procedures (21.4% versus 5.4%; p < 0.001) compared with those in the historical group. In contrast to the historical cases in which the etiologies of constriction were mostly id...