Long-term outcomes of pericardiectomy for constrictive pericarditis

Abstract

BackgroundConstrictive 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.MethodsBetween 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.ResultsThirty 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 post-traumatic 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.ConclusionPericardiectomy 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.

Comparison of early stage electrocardiographic, echocardiographic and histopathologic results of partial pericardiectomy and thoracoscopic pericardial window techniques in an animal model

“…Previous studies have only reported postoperative morbidity and mortality results after pericardiectomy in clinical cases (McCaughan et al, 1985;Hardy et al, 1992;Wood et al, 2002;Schofield et al, 2004;Nath et al, 2014;Bicer et al, 2015;Busch et al, 2015;Vistarini et al, 2015). The question about histopathologic formation of the adjacent surfaces between lung and heart tissues and its effect on heart functions has not been clearly investigated yet.…”

“…disturbance, shock, oliguria and prolonged anesthesia time (Jackson et al, 1999) thoracoscopy is preferred to manage pericardial disease and effusions (Jackson et al, 1999;Palsgaard et al, 2007;Bicer et al, 2015). Considering this and previous postoperative clinical results, comparative investigation of the partial pericardiectomy through thoracotomy and thoracoscopic pericardial window techniques was planned in an experimental animal model.…”

“…Considering this and previous postoperative clinical results, comparative investigation of the partial pericardiectomy through thoracotomy and thoracoscopic pericardial window techniques was planned in an experimental animal model. Because pathologic pericardium disturbs the heart functions and hemodynamic problems causing clinical symptoms, a surgical approach to the pericardial sac is required (Bicer et al, 2015). In the presented study, the well-known pericardiectomy incisions were planned to show the encountered postopera-…”

“…For this purpose, partial and total pericardiectomy are described, and these techniques are performed via a lateral thoracotomy, median sternotomy or thoracoscopic approach (Hardy et al, 1992;Jackson et al, 1999;Dupre et al, 2001;Palsgaard et al, 2007;Vistarini et al, 2015;Case, 2016). Partial pericardiectomy is a valuable treatment for cases with constrictive pericarditis because echocardiographic symptoms of this constriction (progressive fluid overload, reduced cardiac output and right ventricular pressure disturbance) are only terminated by pericardial surgery (Hardy et al, 1992;Bicer et al, 2015;Busch et al, 2015;Vistarini et al, 2015). Thoracoscopic surgery, compared to the open thoracic approach, decreases surgical stress, pain and postoperative complications; as a result, it is recommended as a minimally invasive technique for treating some pericardial diseases in veterinary practice (Dupre et al, 2016;Palsgaard et al, 2007;Case, 2016).…”

Tuberculous pericarditis: Challenges and controversies in the modern era

“…In a smaller cohort of 47 patients (46.8% due to TBP) from Turkey, followed out to 61.2 ± 66 months, the rate of recurrent CP was zero. (53) All but one patient underwent pericardiectomy via median sternotomy with radical pericardial resection. HIV status was not reported on and most patients had a preoperative NYHA class of II or III.…”