Radical pericardiectomy for chronic constrictive pericarditis

Nozohoor, Shahab; Johansson, Maria; Koul, Bansi; Cunha-Goncalves, Doris

doi:10.1111/jocs.13715

Cited by 25 publications

(33 citation statements)

References 19 publications

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“…The surgical methods are classified as complete pericardiectomy and partial pericardiectomy according to the extent of pericardial resection. Complete pericardiectomy has been proven to be not only associated with lower perioperative mortality [9] but also confer significant long-term survival benefit and clinical functional improvement [10,18]. Generally, pericardiectomy can be performed through either median sternotomy or left anterolateral thoracotomy, while median sternotomy provides adequate exposure of the right atrium, right ventricle and the vena cava, thus enabling extensive pericardial resection [19].…”

Section: Discussionmentioning

confidence: 99%

Predictors of postoperative complication and prolonged intensive care unit stay after complete pericardiectomy in tuberculous constrictive pericarditis

Fang

Huang

et al. 2020

J Cardiothorac Surg

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Background: The risk factors of postoperative outcomes after pericardiectomy in tuberculous constrictive pericarditis have still been unclear. This study aimed to investigate the predictors of postoperative complication and prolonged intensive care unit (ICU) stay in the patients with tuberculous constrictive pericarditis undergoing pericardiectomy. Methods: A total of 88 patients with tuberculous constrictive pericarditis undergoing pericardiectomy were retrospectively enrolled. Logistic regression and Cox regression analysis were performed to identify the predictors of postoperative complication and prolonged ICU stay, respectively. Results: All patients underwent complete pericardiectomy and 35 (39.8%) had postoperative complication with no mortality within 30 days after surgery and no in-hospital deaths. Postoperative complication prolonged postoperative ICU stay (P < 0.001), duration of chest drainage (P < 0.001) and postoperative hospital stay (P < 0.001). Preoperative NYHA functional class (P = 0.004, OR 4.051, 95%CI 1.558-10.533) and preoperative central venous pressure (CVP) (P = 0.031, OR 1.151, 95%CI 1.013-1.309) were independent risk factors of postoperative complication. Postoperative complication (P < 0.001, HR 4.132, 95%CI 2.217-7.692) was the independent risk factor for prolonged ICU stay. Conclusion: Complete pericardiectomy was associated with high risk of postoperative complication in tuberculous constrictive pericarditis. Poor preoperative NYHA functional class and high preoperative CVP were shown to predict postoperative complication which was the predictor of prolonged ICU stay.

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Section: Discussionmentioning

confidence: 99%

Predictors of postoperative complication and prolonged intensive care unit stay after complete pericardiectomy in tuberculous constrictive pericarditis

Fang

Huang

et al. 2020

J Cardiothorac Surg

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“…In order to reduce the incidence of postoperative complication and death, some studies have attempted to nd the possible risk factors to improve the strategies of perioperative management. The extent of pericardial resection was one of the risk factors and complete pericardiectomy was associated with superior surgical outcomes to partial pericardiectomy [16,23,24] . Cardiopulmonary bypass was also a predictor of poor prognosis and the 30-day mortality rate might reduce without the use of cardiopulmonary bypass [25] .…”

Section: Discussionmentioning

confidence: 99%

The Optimal Duration of Anti-Tuberculous Therapy Before Pericardiectomy in Constrictive Tuberculous Pericarditis

Fang

Zhong

et al. 2020

Preprint

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Background: It is unclear about the duration of anti-tuberculous therapy before pericardiectomy (DATT) in the patients with constrictive tuberculous pericarditis. This study aims to explore the optimal DATT and its impacts in these patients.Methods: We retrospectively enrolled 93 patients with constrictive tuberculous pericarditis undergoing pericardiectomy and divided them into two groups according to the optimal cutoff value of DATT which was determined by the receiver operating characteristic (ROC) curve and Youden Index. Postoperative and survival outcomes were compared between the two groups.Results: The optimal cutoff value of DATT was 1.05 (months). The enrolled patients were divided into the DATT≤1.05 group and the DATT>1.05 group, with 24 (25.8%) and 69 (74.2%) cases, respectively. Comparing with the DATT≤1.05 group, the DATT>1.05 group had shorter postoperative ICU stay (P=0.023), duration of chest drainage (P=0.002), postoperative hospital stay (P=0.001) and lower incidence of postoperative complications (P<0.001). There was no statistical difference between the two groups in recurrence and survival outcomes.Conclusions: It would be of great benefit to enhanced recovery after pericardiectomy in the patients with constrictive tuberculous pericarditis if DATT lasted for at least one month.

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“…Pericardiectomy is the only definitive treatment for established constriction, and most studies suggest that resection should be as complete as technically feasible [49,[54][55][56][57]. A retrospective review by Nozohoor et al showed that radical pericardiectomy was associated with improved functional status and 10-year survival rates of 94% compared to 55% with subtotal pericardiectomy [55]. Bozbuga et al also showed that performing early radical resection in combination with appropriate chemotherapeutic agents translated into the best outcomes in patients with tuberculous disease [56].…”

Section: Pericardiectomy For Constrictive Pericarditismentioning

confidence: 99%

“…Pericardial stripping is carried out via sternotomy or lateral thoracotomy with or without cardiopulmonary bypass support [49]. Total resection is extremely difficult to perform via a thoracotomy, and median sternotomy is the preferred approach to provide definitive resection and optimise benefit [49,55].…”

Section: Types Of Pericardiectomymentioning

confidence: 99%

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Anaesthesia for Patients with Pericardial Disease

Correia

2019

Inflammatory Heart Diseases

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Patients with pericardial disease can present to the anaesthesiologist for a variety of diagnostic procedures or therapeutic interventions. Providing safe anaesthesia care for these patients is challenging because of their primary pericardial pathology and significant co-morbidities affecting other organ systems. A thorough understanding of the pathophysiology of the pericardial disease state and its effect on overall haemodynamic variables is necessary before formulating a perioperative care plan. A multidisciplinary approach involving cardiology, surgical, anaesthesia and critical care teams is needed to provide optimal peri-operative care. This chapter examines the basic pathophysiology of pericarditis, pericardial effusions, tamponade and constrictive pericarditis as these conditions pertain to the anaesthesiologist in the peri-operative period. Diagnostic tools, especially the role of echocardiography, that aid in the diagnosis and management of these high-risk patients are highlighted.

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Radical pericardiectomy for chronic constrictive pericarditis

Abstract: Radical pericardiectomy provided superior 10-year survival and clinical functional improvement in patients with chronic constrictive pericarditis compared to sub-total pericaridectomy.

Cited by 25 publications

References 19 publications

Predictors of postoperative complication and prolonged intensive care unit stay after complete pericardiectomy in tuberculous constrictive pericarditis

Predictors of postoperative complication and prolonged intensive care unit stay after complete pericardiectomy in tuberculous constrictive pericarditis

The Optimal Duration of Anti-Tuberculous Therapy Before Pericardiectomy in Constrictive Tuberculous Pericarditis

Anaesthesia for Patients with Pericardial Disease

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