Long-term results of radical pericardiectomy for constrictive pericarditis in Korean population

Abstract

BackgroundThe extent of pericardiectomy is an important issue in constrictive pericarditis but its impact on long-term outcomes has been rarely reported. We compared long-term results of radical pericardiectomy with conventional phrenic to phrenic pericardiectomy.MethodsNinety patients who underwent pericardiectomies between February 1995 and April 2015 were reviewed retrospectively. They were classified into conventional (n = 37) and radical (n = 53) groups according to pericardiectomy being performed anterior or posterior to the phrenic nerves, respectively. The follow-up duration at outpatient clinic was 37.6 (11.7, 86.6) months and the survival data until 91.6 (54.5, 147.0) months were obtained. The last echocardiographies were done at 22.4 (4.35, 60.85) months.ResultsThe early mortality rate was 4.4% (4/90). They all belonged to the conventional group and died of low cardiac output syndrome. The survival rate was higher in the radical group (P = .032, 74.7 ± 9.2% versus 50.4 ± 11.9% in 20 years). NYHA class of both groups had recovered until the last follow-up but the radical group showed better recovery (P < .001). The conventional pericardiectomy (HR = 6.181; 95% CI (1.042, 36.656)), redosternotomy (HR = 6.441; 95% CI (1.224, 33.889) and preoperative grade of tricuspid regurgitation (HR = 15.003; 95% CI (1.099, 204.894) were associated with late mortality. Right ventricular systolic pressure decreased, and pericardial thickening resolved only in the radical group with significant intergroup differences as time went on. Tricuspid regurgitation worsened after the operation in both groups, but it deteriorated more in the conventional group. However, it improved over time in the radical group.ConclusionsRadical pericardiectomy led to greater improvement in right ventricular systolic pressure and lesser deterioration of tricuspid regurgitation with the passage of time than did the conventional procedure. Conventional pericardiectomy and preoperative higher grade tricuspid regurgitation were associated with long-term mortality.Electronic supplementary materialThe online version of this article (10.1186/s13019-019-0845-7) contains supplementary material, which is available to authorized users.

Relapsing constrictive pericarditis after implantation of an expanded polytetrafluoroethylene surgical membrane

“…Surgical pericardiectomy can restore the normal physiology, provided that there is no cardiomyopathic component. It has been shown that radical pericardiectomy is superior to conventional in terms of long-term mortality, right ventricular systolic pressure and tricuspidal regurgitation (5) .…”

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

“…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].…”

“…In current clinical practice, the extent of pericardiectomy is varied according to surgeons' experience and surgical difficulty. However, complete pericardiectomy has been reported to be superior to partial pericardiectomy in the improvement of hemodynamics and prognosis [9,10], while the factors influencing the outcomes after pericardiectomy still remain unclear, especially in tuberculous constrictive pericarditis. This study aimed to identify the determinants of postoperative complication and prolonged intensive care unit (ICU) stay after pericardiectomy in tuberculous constrictive pericarditis.…”

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

“…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] .…”