Constrictive pericarditis: risks, aetiologies and outcomes after total pericardiectomy: 24 years of experience

Abstract

Long-term survival after pericardiectomy for constrictive pericarditis is related to underlying aetiology and overall clinical condition. The relatively good survival with idiopathic constrictive pericarditis emphasizes the safety of pericardiectomy in this subgroup.

Surgical Treatment of Constrictive Pericarditis

“…Indeed, idiopathic CP had the best prognosis, with a 7-year Kaplan-Meier survival rate of 88%, followed by postsurgical CP with 66%, and post-irradiation CP with 27%. 10 In a logistic regression analysis, the long-term outcome was predicted by advanced age, increased NYHA class, and post-irradiation exposure. 23 In another study, age, renal failure, pulmonary hypertension, LV dysfunction, and hyponatremia were independent adverse predictors.…”

“…9 Different surgical approaches and techniques, especially median sternotomy versus lateral thoracotomy, partial versus total pericardiectomy, and the need for CPB continue to be debated. 4,6,10,16 Generally, the median sternotomy approach enables a more radical clearance of pericardium overlying the right atrium and venae cavae. 17,18 The left anterolateral thoracotomy approach should be preferred in cases of purulent pericarditis and effusive-constricted pericarditis because of concomitant pyothorax and the risk of sternal infection.…”

“…The operative mortality rate strongly correlates with the preoperative NYHA class. 10 The operative mortality rate also varies widely in accordance with cause. Bertog and colleagues 21 assumed that the higher mortality rate associated with pericardiectomy for post-irradiation (21.4%) and postcardiotomy CP (8.3%) is related to the fact that constriction is not the sole factor producing heart failure in these subgroups.…”

“…For most patients, pericardiectomy is the definitive treatment with an operative risk of 5% to 10% and a late mortality rate of 15% to 70%, depending on several factors. 10 Healthy older patients with mild constriction can be managed conservatively with diuretics.…”

Tuberculous pericarditis: Challenges and controversies in the modern era

“…In a retrospective report conducted during the HIV era, including 121 patients who underwent median sternotomy for CP, the 30-day perioperative mortality rate was excessively high at 14%. (50) In other series reported worldwide this rate stands at 6 -10% (51) . Only 11.6% were HIV positive with 29.8% of cases having confirmed TBP with a further 61.2% having presumed TBP as the cause of their constriction.…”