Pericardiectomy for constrictive pericarditis: a risk factor analysis for early and late failure

Gatti, Giuseppe; Fiore, Antonio; Ternacle, Julien; Porcari, Aldostefano; Fiorica, Ilaria; Poletti, Angelo; Ecarnot, Fiona; Bussani, Rossana; Pappalardo, Aniello; Chocron, Sidney; Folliguet, Thierry; Perrotti, Andréa

doi:10.1007/s00380-019-01464-4

Cited by 26 publications

(37 citation statements)

References 25 publications

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“…Pericarditis remains an infrequent cause of hospital admissions requiring definitive surgical pericardiectomy, even at high volume cardiac centers. Given the relatively variable and high mortality rates following pericardiectomy, there has been significant interest in studying outcomes and risk factors [ 1 – 3 , 7 , 8 , 14 , 21 – 23 ]. Our short- and long- term results are similar to those presented by other investigators [ 1 , 8 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Fifteen-year experience with pericardiectomy at a tertiary referral center

Faiza

Prakash

Namburi

et al. 2021

J Cardiothorac Surg

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Purpose Pericardiectomy has traditionally carried relatively high perioperative mortality and morbidity, with few published reports of intermediate- and long- term outcomes. We investigated our 15-year experience performing pericardiectomy at our institution. Methods Retrospective study of all patients who underwent pericardiectomy at our institution between 2005 and 2019. Baseline demographics, intraoperative details, and postoperative outcomes including long-term survival were analyzed. Results Sixty-three patients were included in the study. 66.7% of subjects underwent isolated pericardiectomy while 33.3% underwent pericardiectomy concomitantly with another cardiac surgical procedure. The most common indications for pericardiectomy were constrictive (79.4%) and hemorrhagic (9.5%) pericarditis. Preoperatively, 76.2% of patients were New York Heart Association class II and III, while postoperatively, 71.4% were class I and II. One-, three-, five-, and ten- year overall mortality was 9.5, 14.3, 20.6, and 25.4%, respectively. Overall pericarditis recurrence rate was 4.8%. Conclusion Pericardiectomy carries relatively high overall mortality rates, which likely reflects underlying disease etiology and comorbidities. Patients with prior cardiac intervention, history of dialysis, and immunocompromised state are associated with worse outcomes.

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Section: Discussionmentioning

confidence: 99%

Fifteen-year experience with pericardiectomy at a tertiary referral center

Faiza

Prakash

Namburi

et al. 2021

J Cardiothorac Surg

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“…The diagnosis of constrictive pericarditis was con rmed by clinical presentation, echocardiographic study, chest computed tomographic (CT) scan and cardiac catheterization, as needed. (Figure 1, Figure 2) [6][7][8][9]…”

Section: Patientsmentioning

confidence: 98%

Analysis of risk factors for early mortality and multiorgan failure after pericardiectomy for constrictive pericarditis

Wen¹,

Lu²,

Lu³

et al. 2020

Preprint

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Background:. The operative mortality of pericardiectomy is still high. This prospective study was to determine the risk factors for early mortality and multiorgan failure.Methods: We prospectively observe patients undergoing pericardiectomy from January 2009 to June 2020 at our hospital. Radical pericardiectomy was performed via sternotomy. Histopathologic studies of pericardum tissue from every patient was done. All survivors were monitored to the end date of the study.Results: 92 consecutive underdoing pericardiectomy for constrictive pericarditis were included in the study. Postoperatively ,CVP decreased significantly, and LVED and LVEF improved significantly. The overall mortality rate was 5.4%. The common postoperative complications inclued acute renal injury（27.2%）, low cardiac output syndrome (10.9% ), and multiorgan failure (8.7%). Analysis of risk factor showed that D2 (fluid balance of the second day following operation) was associated with decreased early mortality and decreased multiorgan failure. In this series from Guagxi, China, characteristic histopathologic features of tuberculosis（60/92,65.2%） of pericardium were the most common histopathologic findings, and 32 patients (32/92,34.8%) had the histopathologic findings of chronic nonspecific inflammatory changes. The functional status of the patients improved after pericardiectomy, 6 months postoperatively 85 survivors were in class I (85/87, 97.7%) and 2 in class II (2/87, 2.3%) .Conclusions: Our results show that pericardiectomy is an effective procedure in the treatment of constrictive pericarditis Early surgical intervention is advocated. Improvement of surgical technique and intraoperative and perioperative management can decrease mortality and morbidity.

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“…Low cardiac output syndrome was defined by a cardiac index (CI) of less than 2.2 L/min/m 2 . Perioperative death was defined as death within 30 days of the operation or during the same hospital admission [Calderon-Rojas 2020;Guerrero Orriach 2019;Gatti 2020].…”

Section: Study Populationmentioning

confidence: 99%

Preoperative Pericardial Effusion is Associated with Low Cardiac Output Syndrome After Pericardiectomy for Constrictive Pericarditis

Wen

et al. 2021

HSF

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Background: Low cardiac output syndrome is the main cause of death after pericardiectomy. Methods: Patients who underwent pericardiectomy for constrictive pericarditis from January 2009 to October 2020 at our hospital were included in the study. Histopathologic studies of pericardium tissue from every patient were performed. All survivors were followed up. Results: Ninety-two consecutive patients underdoing pericardiectomy were included in the study. The incidence of postoperative low cardiac output syndrome was 10.7% (10/92). There were five operative deaths. Mortality and incidence of LCOS in the group with pericardial effusion were significantly higher than those in the group without pericardial effusion. Tuberculosis of the pericardium (60/92, 65.2%) was the most common histopathologic finding in this study. Both univariate and multivariate analyses showed that preoperative pericardial effusion is associated with increased rate of low cardiac output syndrome. Eighty-five survivors were in NYHA class I (85/87, 97.7%), and two were in class II (2/87, 2.3%) at the latest follow up. Conclusions: Preoperative pericardial effusion is associated with low cardiac output syndrome after pericardiectomy. Tuberculosis of the pericardium was the most common histopathologic finding in this study. For constrictive pericarditis caused by tuberculous bacteria, systematic antituberculosis drugs should be given. Preoperative pericardial effusion is associated with increased rate of low cardiac output syndrome. Perfect preoperative preparation is very important to reduce the incidence of postoperative low cardiac output syndrome and mortality. It is very important to use a large dose of diuretics with cardiotonic or vasopressor in a short time after the operation.

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Pericardiectomy for constrictive pericarditis: a risk factor analysis for early and late failure

Cited by 26 publications

References 25 publications

Fifteen-year experience with pericardiectomy at a tertiary referral center

Fifteen-year experience with pericardiectomy at a tertiary referral center

Analysis of risk factors for early mortality and multiorgan failure after pericardiectomy for constrictive pericarditis

Preoperative Pericardial Effusion is Associated with Low Cardiac Output Syndrome After Pericardiectomy for Constrictive Pericarditis

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