Pericardectomy for chronic constrictive pericarditis: risks and outcome

Abstract

From 1970 to 1990, 71 consecutive patients (51 men and 20 women) had pericardectomy for chronic constrictive pericarditis. The mean age was 44.2 +/- 16.1 years. In the preoperative state 2.8% were in NYHA class I, 18.3% in II, 43.6% in III and 35.2% in IV. The operative approach was median sternotomy in 93% and left anterolateral thoracotomy in 7%. The early mortality rate (within 30 days after operation) was 5.6%. All four early deaths were female (P < 0.001), in the preoperative state the patients were classified as NYHA class IV (P < 0.01). These patients had a significantly higher preoperative mean right atrial pressure then survivors (21.5 +/- 8.5 mmHg vs 13.6 +/- 5.6 mmHg, P < 0.005). Follow-up was obtained for 65 patients (91.5%) and averaged 11 +/- 5.8 years (the longest period was 21.5 years). Actuarial survival at 5, 10, 15 and 20 years for all patients was 84.6% +/- 4.5%, 80.1% +/- 5.3%, 70.5% +/- 6.9% and 65.8% +/- 7.9%, respectively. In the preoperative state 10 of the 12 late deaths (83%) were classified NYHA class IV and the remaining ones class III. Of the 49 patients alive 23% belong to NYHA class I, 42% to II and 35% to III; none is in class IV. Negative predictors of survival were found to be preoperative NYHA class IV (P < 0.01), low-voltage electrocardiogram (ECG) (P < 0.01), ascites (P < 0.01), dyspnea at rest (P < 0.05) and hyperbilirubinemia (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Tuberculous Pericarditis

“…15 Four pathological stages of tuberculous pericarditis are recognized: (1) fibrinous exudation with initial polymorphonuclear leukocytosis, relatively abundant mycobacteria, and early granuloma formation with loose organization of macrophages and T cells; (2) serosanguineous effusion with a predominantly lymphocytic exudate with monocytes and foam cells; (3) absorption of effusion with organization of granulomatous caseation and pericardial thickening caused by fibrin, collagenosis, and ultimately, fibrosis; and (4) constrictive scarring: the fibrosing visceral and parietal pericardium contracts on the cardiac chambers and may become calcified, encasing the heart in a fibrocalcific skin that impedes diastolic filling and causes the classic syndrome of constrictive pericarditis. 16 Recent data suggest that the histological pattern is affected by the immune status of the patient, with fewer granulomas being observed in HIV-infected patients with severely depleted CD4 lymphocytes. 17 The lymphatic drainage of the pericardium is primarily to the anterior and posterior mediastinal and tracheobronchial lymph nodes and is reflected by the pattern of lymphadenopathy seen in tuberculous pericarditis.…”

Canadian Cardiovascular Society Consensus Conference guidelines on heart failure, update 2009: Diagnosis and management of right-sided heart failure, myocarditis, device therapy and recent important clinical trials

“…Current surgical mortality rates average 6% to 12% (56,57), but can be elevated further if there is coexisting myocardial damage, extensive pericardial calcification ('outer porcelain heart') or previous mediastinal radiation. Optimal timing for pericardiectomy is not known, although survival is lower among patients with more severe symptoms of heart failure at surgery (57,58).…”

68-Year-Old Woman With Chronic Cough and Recurrent Pleural Effusions

“…Large series have demonstrated the efficacy of pericardiectomy for constrictive pericarditis, 9 but early deaths occur from low-output syndrome regardless of surgical technique. 4 One recent study showed that patients with abnormal left ventricular contractility and relaxation properties assessed by preoperative cardiac catheterization had a higher mortality rate.…”