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

Abstract

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.

Outcome of Pericardiectomy for Constrictive Pericarditis: Single Center Experience

“…We think that bypass per se is not the main issue, but concomitant cardiac surgical procedure and severe constrictions requiring bypass are behind poor late outcome. We agree with Chowdhury et al that pericardiectomy with CBP is needed in cases with previous cardiac surgery and severe calcification, for associated cardiac surgery, or in events of cardiac injury or massive bleeding [14]. CPB was conducted in 5 patients of our series (4 for associated cardiac procedure and one for repair of IVC injury).…”

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

“…After pericardiectomy, the heart is in a high volume load state in a short period of time.At this time, usage of large amount of diuretics becomes feasible and necessary, which is also one of the key points for further improvement of cardiac function after operation. [22][23][24] The following measures are important to decrease the operative mortality risk of pericardiectomy. 1strengthen nutrition before operation to improve general condition, intermittently input of plasma or albumin to increase colloidal osmotic pressure, and Aggressive diuresis is completed to reduce tissue edema to reduce the amount of blood returning the heart postoperatively.…”

Fluid Balance of the Second Day Following Operation is Associated with Early Mortality and Multiorgan Failure After Pericardiectomy for Constrictive Pericarditis

“…Dopamine and other catecholamines should be used. If the drug response is poor and the low cardiac output cannot be corrected, ECMO should be used [Unai 2019;Yunfei 2019].…”