A 20-year experience with isolated pericardiectomy: Analysis of indications and outcomes

Gillaspie, Erin A.; Stulak, John M.; Daly, Richard C.; Greason, Kevin L.; Joyce, Lyle D.; Oh, Jae K.; Schaff, Hartzell V.; Dearani, Joseph A.

doi:10.1016/j.jtcvs.2016.03.098

Cited by 60 publications

(60 citation statements)

References 20 publications

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“…The choice among median sternotomy, left anterolateral thoracotomy and bilateral anterior thoracotomy seem to be individual preference for the first pericardiectomy [3–5]. The two surgical approaches (median sternotomy or left thoracotomy) were not related to the differences in overall survival for the first pericardiectomy [1]. Till today there has not been any specific study which has addresses these approaches in the setting of recurrent constrictive pericarditis after first median sternotomy pericardiectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Chronic constrictive pericarditis is a disease which is characterized by noticeable thickening as well as thick scarring of the pericardium with pericardial sac obliteration, or calcification of the pericardium. Surgical pericardiectomy is extremely effective and possibly restorative for the heart failure [1]. However, some patients still have recurrent pericarditis.…”

Section: Introductionmentioning

confidence: 99%

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Re-pericardiectomy for recurrent chronic constrictive pericarditis: left anterolateral thoracotomy is a better approach

Qian

2019

J Cardiothorac Surg

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Background Pericardiectomy is the final treatment for constrictive pericarditis. However, this greatest surgical approach is still very controversial. This study pursued to assess the outcomes in patients with recurrent chronic constrictive pericarditis undergoing reoperated pericardiectomy via median sternotomy versus left anterolateral thoracotomy and to explain which surgical approaches might be better for recurrent chronic constrictive pericarditis. Methods A total of 24 patients were identified with recurrent chronic constrictive pericarditis and underwent reoperation with pericardiectomy between July 2003 and July 2015. The decision for this surgical approach was mainly dependent on the operating surgeon’s preference. Out of 20 patients, 16 patients underwent pericardiectomy via median sternotomy and 8 patients via left anterolateral thoracotomy pericardiectomy. Their data were obtained retrospectively from the case notes. Results Both groups of patients were similar in age, gender between two operations, and also in peripheral venous pressure, cardiac rhythm and New York Heart Association (NYHA) class distribution. The mortality rates were similar in both groups with one death (12.5%) due to low cardiac output syndrome in the left anterolateral thoracotomy group and two deaths (12.5%) in the median sternotomy group. All the deaths were associated with cardiac complications and happened in the perioperative period. NYHA functional class status enhanced in most of the patients. Patients in both groups had a similar and significant improvement in their NYHA status that improved from 3.4 ± 0.7 to 1.8 ± 0.1 ( P = 0.001) in the left anterolateral thoracotomy group and reduced from 3.3 ± 0.6 to 1.9 ± 0.4 ( P = 0.001) in the median sternotomy group. There was a significantly greater rate of pulmonary infection in the thoracotomy group than in the median sternotomy group (50% versus 25%, P = 0.02). Nevertheless, there was a significantly greater occurrence of wound infections in the median sternotomy group in 3 patients versus in one patient of the left anterolateral thoracotomy group (18.8% versus 12.5%, P = 0.02). Conclusions Left thoracotomy incision was preferred to sternotomy in the current setting of this situation and was done safely without CPB. It avoided life-threatening sternal infection and it also has showed an equal as well las significant enhancement of NYHA status of the patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Re-pericardiectomy for recurrent chronic constrictive pericarditis: left anterolateral thoracotomy is a better approach

Qian

2019

J Cardiothorac Surg

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“…Overall early mortality rate after pericardiectomy is reported to be 2.5 % nowadays [1]. The waffle procedure, ultrasonic scalpel, aspirator, and off-pump procedure contribute to reduce the risk of this surgery [2,3,5].…”

Section: Discussionmentioning

confidence: 99%

“…Constrictive pericarditis (CP) is an uncommon chronic inflammatory condition characterized by pericardial fibrosis and occasional calcification that limits diastolic ventricular filling. In cases where medical treatment is not effective, surgical intervention is demanded [1].…”

Section: Introductionmentioning

confidence: 99%

Calcified constrictive pericarditis treated with ultrasonic devices

Park¹,

Ujihira²,

Osaki³

2018

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A 52-year-old male patient was diagnosed as constrictive pericarditis with severe diastolic dysfunction, which was characterized by broadly calcified pericardium on fragile parts of the heart: the right atrium, both coronary vessels as well as the right and left ventricles. We successfully conducted a total pericardiectomy with an ultrasonic aspirator to break the calcified pericardium into smaller parts and an ultrasound scalpel to peel off the debris.

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“…In einer Studie konnten die positiven Auswirkungen einer subtotalen chirurgischen Perikardektomie für Patienten mit konstriktiver Perikarditis gezeigt werden[43]. Gillaspie et al[44] konnten zeigen, dass eine radikale Perikardektomie bei IRP-Patienten häufiger zu einem Langzeitüberleben führte als eine partielle Perikardektomie mit zusätzlicher medikamentöser Therapie. In der untersuchten Kohorte betrug die Gesamtüberlebenszeit nach Perikardektomie 80 % nach 5 Jahren und 60 % nach 10 Jahren.…”

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Perikarditis im Rahmen rheumatologischer Erkrankungen – Was der Rheumatologe wissen sollte

2020

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ZusammenfassungAls Perikarditis wird eine Entzündung des Herzbeutels bezeichnet, die mit einem Perikarderguss oder einer entzündlichen Reaktion des Myokards (Perimyokarditis) einhergehen kann. Die Perikarditis kann im Rahmen von entzündlich rheumatischen Systemerkrankungen oder als eigenständige Erkrankung vorkommen. Rezidivierende Perikarditisepisoden ohne fassbare Ursache werden als idiopathische rekurrierende Perikarditis (IRP) bezeichnet, welche wesentliche Gemeinsamkeiten mit autoinflammatorischen Erkrankungen aufweist. Der Artikel gibt einen Überblick über die Häufigkeit des Auftretens einer Perikarditis bei rheumatologischen Erkrankungen. Weiterhin werden Klinik und Pathophysiologie der IRP diskutiert. Abschließend wird die Therapie der akuten und idiopathischen Perikarditis erläutert.

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A 20-year experience with isolated pericardiectomy: Analysis of indications and outcomes

Cited by 60 publications

References 20 publications

Re-pericardiectomy for recurrent chronic constrictive pericarditis: left anterolateral thoracotomy is a better approach

Re-pericardiectomy for recurrent chronic constrictive pericarditis: left anterolateral thoracotomy is a better approach

Calcified constrictive pericarditis treated with ultrasonic devices

Perikarditis im Rahmen rheumatologischer Erkrankungen – Was der Rheumatologe wissen sollte

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