Our experience of total pericardiectomy for constrictive pericarditis: a comprehensive analysis over a period of 5 years

Abstract

Introduction Constrictive pericarditis (CP) usually presents as a result of chronic fibrous pericardial thickening and calcification of the pericardium which causes reduced cardiac output. Despite the lack of prospective studies comparing the different therapeutic strategies, surgical pericardiectomy is a valuable treatment under most circumstances. Aim We analyzed our records to highlight the predictors of morbidity and mortality of pericardiectomy and also short-term surgical outcome of the same procedure in a single center. Material and methods We carried out a comprehensive retrospective analysis of the records of patients who underwent surgery for CP at our institute between 2013 and 2018. 30 patients underwent isolated pericardiectomy. All patients underwent median sternotomy and total pericardiectomy without the use of cardiopulmonary bypass. Pre-operative, intra-operative and post-operative characteristics were noted. Results Fifteen patients had a history of pulmonary tuberculosis. The majority of the patients presented with NYHA grade III or IV. 60% of the patients were male. The preoperative mean central venous pressure was 24 ±9 mm Hg and decreased to 9 ±5 mm Hg after surgery. The 30-day mortality was 6.66% (2/30). Morbidity was mainly due to low-cardiac output syndrome ( n = 4). A total of 26 patients had significant improvement in their NYHA status. Conclusions Although pericardiectomy for CP remains associated with some operative mortality, the short-term outcome is favorable, and surgical treatment is able to improve the functional class in the majority of survivors.

Pericardiectomy for Constrictive Tuberculous Pericarditis: A Systematic Review and Meta-analysis on the Etiology, Patients’ Characteristics, and the Outcomes.

“…The pooled result shows lower but insignificant in-hospital mortality in comparison to one-year mortality in patients undergoing pericardiectomy for constrictive pericarditis (RR 0.59, CI [0.11,3.11], I2= 61%). Jadhao et al [ 15 ], Kang et al [ 2 ], Karima et al [ 13 ], Lin et al [ 9 ] are the studies evaluated in the forest plot.…”

“…Postoperative hospital stays: The mean postoperative hospital stays in studies with mixed etiologies is 19.40 (11.93, 26.87) (Figure 12 ), with a mean standard deviation of 8.26 (4.21, 12.52) (Figure 13 ). Murat2015: Bicer et al [ 11 ], Tamallah2020: Karima et al [ 13 ], Manish2020: Jadhao et al [ 15 ], Yiyun2012: Lin et al [ 9 ], Se Hung Kang2014: Kang et al [ 2 ], Li: Zhang et al [ 8 ] are the studies used to evaluate the outcomes in studies with mixed etiologies.…”