Does tuberculosis affect surgical outcomes following pericardiectomy for chronic constrictive pericarditis? Twelve years’ experience from a tertiary care center in India
“…As a matter of fact, patients with CP secondary to cardiac surgery have significantly higher risk of all-cause mortality after pericardiectomy when compared with patients with idiopathic etiology (HR: 2.15; 95% CI: 1.21 to 3.61, p = 0.01), with even worse outcomes when CP secondary to radiotherapy is compared with idiopathic etiology (HR: 3.21; 95% CI: 1.56 to 6.50, p < 0.01) [2]. Finally, pericardiectomy performed in patients with CP secondary to tuberculosis, the most common etiology observed in developing countries, has been recently reported to have similar outcomes with respect to other etiologies, although with more technical complexity in terms of increased operative time, more blood loss, and prolonged ICU and hospital stay [3].…”
Section: Prognosismentioning
confidence: 99%
“…Nonetheless, taking into account socioeconomic background, tuberculosis infections and, along with them, late complications like CP are significantly increasing in developing countries. Consequently, tuberculosis has become the first cause of CP in countries of sub-Saharan Africa and few countries of Asia, including India where tuberculosis was associated with more than half of cases of CP (51.6%) in a retrospective single-center analysis, including patients submitted to pericardiectomy between 2009 and 2020 [3].…”
Constrictive pericarditis (CP) is a challenging clinical scenario in which the heart muscle is entrapped by thick, fibrous, and frequently calcified pericardial layers. Whereas infectious diseases (mostly bacterial) had been observed as the main etiology in the last decades, nowadays, post-surgical or radiotherapy iatrogenic inflammation is becoming highly prevalent with the exception of developing countries and patients with immunodeficiency in which tuberculosis is still frequently observed. Clinically, progressive dyspnea and peripheral edema are present and frequently considered of unknown origin because of the diagnostic challenge that CP poses. As a matter of fact, a specific knowledge of echocardiography and right heart catheterization is essential to recognize constriction features. Moreover, a valuable support is provided by dedicated imaging modalities (mostly magnetic resonance). Complete surgical removal of the pericardium (pericardiectomy), when feasible and performed early, is associated with excellent symptomatic improvement. Unfortunately, in specific scenarios (radiation therapy) or when surgery is performed after severe constriction development, surgical outcomes are poor, and CP assumes the profile of an end-stage disease. This reinforces the unmet need of early detection of CP and the development of novel therapeutic strategies.
“…As a matter of fact, patients with CP secondary to cardiac surgery have significantly higher risk of all-cause mortality after pericardiectomy when compared with patients with idiopathic etiology (HR: 2.15; 95% CI: 1.21 to 3.61, p = 0.01), with even worse outcomes when CP secondary to radiotherapy is compared with idiopathic etiology (HR: 3.21; 95% CI: 1.56 to 6.50, p < 0.01) [2]. Finally, pericardiectomy performed in patients with CP secondary to tuberculosis, the most common etiology observed in developing countries, has been recently reported to have similar outcomes with respect to other etiologies, although with more technical complexity in terms of increased operative time, more blood loss, and prolonged ICU and hospital stay [3].…”
Section: Prognosismentioning
confidence: 99%
“…Nonetheless, taking into account socioeconomic background, tuberculosis infections and, along with them, late complications like CP are significantly increasing in developing countries. Consequently, tuberculosis has become the first cause of CP in countries of sub-Saharan Africa and few countries of Asia, including India where tuberculosis was associated with more than half of cases of CP (51.6%) in a retrospective single-center analysis, including patients submitted to pericardiectomy between 2009 and 2020 [3].…”
Constrictive pericarditis (CP) is a challenging clinical scenario in which the heart muscle is entrapped by thick, fibrous, and frequently calcified pericardial layers. Whereas infectious diseases (mostly bacterial) had been observed as the main etiology in the last decades, nowadays, post-surgical or radiotherapy iatrogenic inflammation is becoming highly prevalent with the exception of developing countries and patients with immunodeficiency in which tuberculosis is still frequently observed. Clinically, progressive dyspnea and peripheral edema are present and frequently considered of unknown origin because of the diagnostic challenge that CP poses. As a matter of fact, a specific knowledge of echocardiography and right heart catheterization is essential to recognize constriction features. Moreover, a valuable support is provided by dedicated imaging modalities (mostly magnetic resonance). Complete surgical removal of the pericardium (pericardiectomy), when feasible and performed early, is associated with excellent symptomatic improvement. Unfortunately, in specific scenarios (radiation therapy) or when surgery is performed after severe constriction development, surgical outcomes are poor, and CP assumes the profile of an end-stage disease. This reinforces the unmet need of early detection of CP and the development of novel therapeutic strategies.
“…TB and post-infectious constriction emerge as primary contributors to pericarditis in LMICs like Brazil [12]. This is particularly significant as pericardial diseases of tuberculous origin are linked to heightened perioperative fatality rates and considerable morbidity [13,14]. A study found that the overall mortality ratio in presumed tuberculous pericarditis patients was 26% for a period of six months since being diagnosed [34].…”
Section: Pericardial Diseases Mortality Rates Based On Sex and Agementioning
confidence: 99%
“…Lowand middle-income countries (LMICs), like Brazil, often see post-infectious constriction and TB as the predominant causes [12]. Notably, pericarditis of tuberculous origin is associated with higher perioperative fatality rates and substantial morbidity during pericardiectomy procedures [13,14]. Additionally, alongside HIV and acquired immunodeficiency syndrome (AIDS), and TB, arboviral infections such as dengue and Zika viruses are endemic in countries like Brazil [15].…”
BackgroundPericardial diseases manifest in various clinical forms, including acute pericarditis, constrictive pericarditis, pericardial effusion, and cardiac tamponade, with acute pericarditis being the most prevalent. These conditions significantly contribute to mortality rates. Therefore, this article aimed to analyze mortality trends in the Brazilian population based on age and sex, shedding light on the impact of pericardial diseases on public health outcomes.
MethodsThis is a retrospective time-series analysis of pericardial disease mortality rates in Brazil (2000Brazil ( -2022. Data was obtained from the Department of Informatics of the Unified Health System (DATASUS), and the 10th edition of the International Classification of Diseases (ICD-10) codes: I30, I31, and I32 were included for analysis. We gathered population and demographic data categorized by age range and sex from the Brazilian Institute of Geography and Statistics (IBGE). Subsequently, we computed the age-standardized mortality rate per 100,000 individuals and assessed the annual percentage changes (APCs) and average annual percentage changes (AAPCs) using joinpoint regression, along with their corresponding 95% confidence intervals (CIs).
ResultsIn terms of mortality trends based on sex, overall mortality rates remained stable for males and combined sexes over the study period. However, there was a notable increase in mortality rates among females (AAPC=1.18), particularly between 2020 and 2022, with a significant APC of 27.55. Analyzing pericardial diseases across different age groups (20 to 80 years and above), it wasobserved that mortality rates significantly increased in the 70-79 and 80 years and above age groups throughout the study period (AAPC=1.0339 and AAPC=3.4587, respectively). These two age groups experienced the highest significant rise in mortality between 2020 and 2022. Other age groups did not exhibit a significant change in AAPC.
ConclusionsThis comprehensive analysis spanning two decades , examined the mortality trends of pericardial diseases in Brazil and revealed relative stability overall. Males exhibited an overall higher mortality number due to pericardial diseases; however, females showed the most significant increase in mortality trend throughout the whole period. In the first segment (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015), mortality rose across all cohorts, which was attributed to substandard healthcare facilities and infectious diseases like tuberculosis. The second segment (2016-2020) saw a decline in mortality, likely due to improved healthcare, particularly the increased availability of echocardiograms. However, the third segment (2020-2022) witnessed a sharp rise in mortality, coinciding with the COVID-19 pandemic, with post-COVID-19 symptoms, particularly pericarditis. Pericarditis-related death rates declined compared to pericardial effusion, and mortality rates correlated directly with age, with older cohorts experiencing higher mortality due to incr...
“…Histopathologic studies of pericardium tissue from patients with idiopathic or viral pericarditis show chronic nonspecific inflammatory changes ( Figure 4 ). 8–11 Figure 1 Transthoracic echocardiography showed the significantly thickened pericardium. Figure 2 Chest computed tomographic scan showed the noticeably thickened and calcified ring of the pericardium.…”
Section: Diagnosis Of Constrictive Pericarditismentioning
Aim
We aim to access the effect of pericardiectomy for constrictive pericarditis with or without cardiopulmonary bypass.
Methods
This was a review of pericardiectomy for constrictive pericarditis.
Results
Cardiopulmonary bypass is actually an important maneuver to attain complete relief of the constriction. The short additional time of cardiopulmonary bypass during the procedure has very little effect on the risk of morbidity of the main operation.
Conclusion
Incomplete pericardiectomy perhaps was the cause of postoperative remnant constriction and high diastolic filling pressure leading to multiorgan failure. Complete pericardiectomy (removal of phrenic-to-phrenic and the postero-lateral and inferior wall pericardial thickening) using cardiopulmonary bypass should be the routine for total relief of the constriction of the heart.
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