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

Fang, Lingling; Yu, Guocan; Huang, Junhua; Zhao, Wuchen; Ye, Bo

doi:10.1186/s13019-020-01198-9

Cited by 12 publications

(10 citation statements)

References 25 publications

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“…Other factors that may predict poor long-term survival include higher pulmonary artery systemic pressure, abnormal LV systolic function, lower sodium level, and older age. Factors such as pre-operative NYHA functional class, pre-operative RV dilatation, pre-operative central venous pressure, and reduced LV systolic function are predictors of early post-operative and 30-day mortality [ 71 , 72 ].…”

Section: Role Of Multimodality Imaging In Pre-operative Planning and ...mentioning

confidence: 99%

Multimodality Imaging of Constrictive Pericarditis: Pathophysiology and New Concepts

et al. 2022

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Purpose of Review The unique pathophysiological changes of constrictive pericarditis (CP) can now be identified with better imaging modalities, thereby helping in its early diagnosis. Through this review, we outline the pathophysiology of CP and its translation into symptomology and various imaging findings which then are used for both diagnosis and guiding treatment options for CP. Recent Findings Multimodality imaging has provided us with the capability to recognize early stages of the disease and identify patients with a potential for reversibility and can be treated with medical management. Additionally, peri-procedural planning and prediction of post-operative complications has been made possible with the use of advanced imaging techniques. Summary Advanced imaging has the potential to play a greater role in identification of patients with reversible disease process and provide peri-procedural risk stratification, thereby improving outcomes for patients with CP.

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Section: Role Of Multimodality Imaging In Pre-operative Planning and ...mentioning

confidence: 99%

Multimodality Imaging of Constrictive Pericarditis: Pathophysiology and New Concepts

et al. 2022

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“…Despite being considered effective, pericardiectomy is associated with non-negligible risk of postoperative complications and in-hospital mortality. There have been a number of studies exploring the risk factors of poor outcomes after pericardiectomy, and the results showed that surgical outcomes depended heavily on the functional status of patients, the etiology of constrictive pericarditis, the timing of surgical intervention, the extent of pericardial resection and the need for cardiopulmonary bypass [16][17][18][19][20]. However, most of the studies represented single-center and retrospective experiences.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of matrix metalloprotease 9 on surgical outcomes after pericardiectomy

Fang

et al. 2022

J Cardiothorac Surg

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Background The effects of matrix metalloproteases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) expressions on the patients with constrictive pericarditis undergoing pericardiectomy remain unclear. This study explored the associations of MMPs and TIMPs expressions with postoperative outcomes in these patients. Methods Pericardial specimens were obtained during pericardiectomy from the patients with constrictive pericarditis. The levels of MMP1, MMP2, MMP9 and TIMP1 in pericardium were analyzed by quantitative real-time polymerase chain reaction. The enrolled patients were divided into two groups according to the optimal cutoff value of gene expression predicting postoperative complications. Postoperative outcomes were compared between the two groups. Binary logistic regression analysis was performed to determine the degree of contribution of gene expression on postoperative outcomes. Results A total of 22 patients and their pericardial specimens were included. The level of MMP9 was significantly associated with postoperative complications and the optimal cutoff value predicting postoperative complications was 3.67. The patients with low level of MMP9 (< 3.67) had lower incidence of postoperative complications (P = 0.002), shorter postoperative intensive care unit (P = 0.040) and hospital stay (P = 0.043) in comparison to those with high level of MMP9 (≥ 3.67). Binary logistic regression analysis showed that high level of MMP9 increased the risk of postoperative complications (OR 27.096, 95% CI 1.166–629.886, P = 0.040). Conclusions High level of MMP9 in the pericardium was associated with poor postoperative outcomes and was the independent risk factor of postoperative complications. The level of MMP9 could be used as a potential marker for prediction of surgical outcomes.

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“…Multiple studies have reported the negative impact of renal dysfunction on patient outcomes and medical costs in pericardiectomy (4,5,16,17), but the predictors of renal dysfunction have hardly been investigated. Huang et al studied the clinical features of ninety-two patients with constrictive pericarditis, and reported that ventilator time, postoperative creatinine levels and blood transfusion were associated with acute kidney injury after pericardiectomy, with no preoperative factors involved.…”

Section: Discussionmentioning

confidence: 99%

A Prediction Model for Acute Kidney Injury After Pericardiectomy: An Observational Study

Wang

Zhang

et al. 2022

Front. Cardiovasc. Med.

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ObjectivesAcute kidney injury is a common complication after pericardiectomy for constrictive pericarditis, which predisposes patients to worse outcomes and high medical costs. We aimed to investigate potential risk factors and consequences and establish a prediction model.MethodsWe selected patients with constrictive pericarditis receiving isolated pericardiectomy from January 2013 to January 2021. Patients receiving concomittant surgery or repeat percardiectomy, as well as end-stage of renal disease were excluded. Acute kidney injury was diagnosed and classified according to the KDIGO criteria. Clinical features were compared between patients with and without postoperative acute kidney injury. A prediction model was established based on multivariable regression analysis.ResultsAmong two hundred and eleven patients, ninety-five (45.0%) developed postoperative acute kidney injury, with fourty-three (45.3%), twenty-eight (29.5%), and twenty-four (25.3%) in mild, moderate and severe stages, respectively. Twenty-nine (13.7%) patients received hemofiltration. Nine (4.3%) patients died perioperatively and were all in the acute kidney injury (9.5%) group. Eleven (5.2%) patients were considered to have chronic renal dysfunction states at the 6-month postoperative follow-up, and eight (72.7%) of them experienced moderate to severe stages of postoperative acute kidney injury. Univariable analysis showed that patients with acute kidney injury were older (difference 8 years, P < 0.001); had higher body mass index (difference 1.68 kg·m−2, P = 0.002); rates of smoking (OR = 2, P = 0.020), hypertension (OR = 2.83, P = 0.004), and renal dysfunction (OR = 3.58, P = 0.002); higher central venous pressure (difference 3 cm H2O, P < 0.001); and lower cardiac index (difference −0.23 L·min−1·m−2, P < 0.001) than patients without acute kidney injury. Multivariable regression analysis showed that advanced age (OR 1.03, P = 0.003), high body mass index (OR 1.10, P = 0.024), preoperative atrial arrhythmia (OR 3.12, P = 0.041), renal dysfunction (OR 2.70 P = 0.043), high central venous pressure (OR 1.12, P = 0.002), and low cardiac index (OR 0.36, P = 0.009) were associated with a high risk of postoperative acute kidney injury. A nomogram was established based on the regression results. The model showed good model fitness (Hosmer-Lemeshow test P = 0.881), with an area under the curve value of 0.78 (95% CI: 0.71, 0.84, P < 0.001).ConclusionThe prediction model may help with early recognition, management, and reduction of acute kidney injury after pericardiectomy.

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

Cited by 12 publications

References 25 publications

Multimodality Imaging of Constrictive Pericarditis: Pathophysiology and New Concepts

Multimodality Imaging of Constrictive Pericarditis: Pathophysiology and New Concepts

Predictive value of matrix metalloprotease 9 on surgical outcomes after pericardiectomy

A Prediction Model for Acute Kidney Injury After Pericardiectomy: An Observational Study

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