Surgical experience on chronic constrictive pericarditis in African setting: review of 35 years’ experience in Cote d’Ivoire

Yangni-Angate, Koffi Herve; Tanauh, Y.; Meneas, Christophe; Diby, F.; Adoubi, A.; Diomande, Manga

doi:10.21037/cdt.2016.09.06

Cited by 11 publications

(31 citation statements)

References 14 publications

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“…Two studies reported on the outcome of pericardiectomy in large cohorts of patients with constrictive pericarditis. Both showed a consistent mortality rate of 14% in a group of patients in South Africa26 and 12.5% in a study in Ivory Coast 38. The other smaller studies were case series that showed a good clinical benefit and low perioperative complications rate of pericardiectomy or pericardiostomy for constrictive pericarditis or large pericardial effusions 24 29 40–42…”

Section: Resultsmentioning

confidence: 93%

Epidemiology of pericardial diseases in Africa: a systematic scoping review

Noubiap

Agbor

Ndoadoumgue

et al. 2018

Heart

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ObjectivesThis scoping review sought to summarise available data on the prevalence, aetiology, diagnosis, treatment and outcome of pericardial disease in Africa.MethodsWe searched PubMed, Scopus and African Journals Online from 1 January 1967 to 30 July 2017 to identify all studies published on the prevalence, aetiologies, diagnosis, treatment and outcomes of pericardial diseases in adults residing in Africa.Results36 studies were included. The prevalence of pericardial diseases varies widely according to the population of interest: about 1.1% among people with cardiac complaints, between 3.3% and 6.8% among two large cohorts of patients with heart failure and up to 46.5% in an HIV-infected population with cardiac symptoms. Tuberculosis is the most frequent cause of pericardial diseases in both HIV-uninfected and HIV-infected populations. Patients with tuberculous pericarditis present mostly with effusive pericarditis (79.5%), effusive constrictive pericarditis (15.1%) and myopericarditis (13%); a large proportion of them (up to 20%) present in cardiac tamponade. The aetiological diagnosis of pericardial diseases is challenging in African resource-limited settings, especially for tuberculous pericarditis for which the diagnosis is not definite in many cases. The outcome of these diseases remains poor, with mortality rates between 18% and 25% despite seemingly appropriate treatment approaches. Mortality is highest among patients with tuberculous pericarditis especially those coinfected with HIV.ConclusionPericardial diseases are a significant cause of morbidity and mortality in Africa, especially in HIV-infected individuals. Tuberculosis is the most frequent cause of pericardial diseases, and it is associated with poor outcomes.

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Section: Resultsmentioning

confidence: 93%

Epidemiology of pericardial diseases in Africa: a systematic scoping review

Noubiap

Agbor

Ndoadoumgue

et al. 2018

Heart

View full text Add to dashboard Cite

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“…It still prevails to be the most final diagnostic assessment in sub-Saharan Africa. In his study, Yangni-Angate et al [21] reported that cardiac catheterization confirmed a dip-and-plateau (square root sign), an equalization of end-diastolic pressures in right and/or left cardiac chambers ranged between 10 and 40 mmHg, a mean cardiac index (CI): 2.3 l/min/m 2 (extremes: 1.3-3.6). From this author, the constriction was limited to the right cardiac cavities called right constriction (n = 54, 45%) or to the right and left cardiac cavities called bilateral constriction (n = 66, 55%) and hemodynamic parameters and cineangiograms confirmed the diagnosis of pericardial constriction in all the patients.…”

Section: Diagnosismentioning

confidence: 93%

“…In African countries [18][19][20][21][22][23][24][25][26], the diagnosis of constrictive pericarditis is usually obvious for patients present late after the development of the constrictive process characterized mostly by advanced clinical manifestations of right-sided heart failure (50-100%), progressive New York Heart Association (NYHA) Functional Class III or IV (42-100%) associated with an evident antecedent pulmonary and extra-pulmonary tuberculosis such as tuberculous pericarditis (26-99%). Duration of illness prior to surgery may range from 1 month to 25 years with an average of 15 or 30 months found, respectively, by Ali et al [26] and Yangni-Angate et al [21].…”

Section: Diagnosismentioning

confidence: 99%

“…Generally, male gender predominance is noted (60-80%), patients have an average age below 40 years; for instance in Morocco (32 years) [18], Ghana (33 years) [22], Senegal (23 years) [20], Gabon (36 years) [23], Cote d'Ivoire (28.8 years) [21], and Ethiopia (24.3 years) [26]. Main clinical findings often due to severe constriction include: hepatomegaly (74-100%), raised jugular venous pressure (76-100%), hepato-jugular reflux (67-100%), ascite (50-76%), peripheral edema (46-79%), complete "Pick Syndrome"(50-76%).…”

Section: Diagnosismentioning

confidence: 99%

“…In African setting, frequent radiographical findings at chest X-ray are as follows: enlarged cardiothoracic ratio or cardiomegaly (88-47%), calcifications (36-52.5%), and pleural effusion (44-63%); electrocardiography shows invariable modifications such as low QRS voltage (32.5-82.5%), atrial fibrillation (18-46%), and T wave abnormality up to 87.5%. Echocardiography is largely available and is useful for accurate assessment in revealing in most cases a thickened pericardium (56 and 100%), pericardial calcifications in 30.2%, 47.4% of cases according to authors and left ventricular septal motion abnormality (63.6%) with reduced ejection fraction below 0.60 in Rabat, Morocco [19]; cardiac catheterization performed only in a very few centers [21,24,25,27] documents elevation and equalization of diastolic heart pressures with the typical dip-plateau waveform of constrictive pericarditis and evaluate the stroke volume, cardiac output, and myocardial systolic function. It still prevails to be the most final diagnostic assessment in sub-Saharan Africa.…”

Section: Diagnosismentioning

confidence: 99%

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Chronic Constrictive Pericarditis (CCP) in Africa: Epidemiology, Etiology, Diagnosis, and Surgical Treatment

Yangni-Angate¹

2019

Inflammatory Heart Diseases

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Chronic constrictive pericarditis (CCP) is not rare in Africa with tuberculosis as the most common etiology. A long history of visceral tuberculosis, typical symptoms of CCP because of late clinical presentation in most cases, make diagnosis almost easy to establish. Echocardiography and cardiac catheterization may be helpful as final investigation when differentiation between CCP, endomyocardial fibrosis, and restrictive ventricular heart disease is difficult to attest. Pericardiectomy remains the only efficient treatment to carry out. We review the African teams' surgical experiences on pericardiectomy and report their surgical results and those worldwide in literature overall. In African groups, early mortality varies from 0 to 22% versus 2.1 to 18.6% outside Africa associated with New York Heart Association Functional Class IV as the most common significant risk factor for early deaths in all series in the World, including Africa.

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Pericardiectomy for constrictive pericarditis: a risk factor analysis for early and late failure

et al. 2019

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Predictors of early and late failure of pericardiectomy for constrictive pericarditis (CP) have not been established. Early and late outcomes of a cumulative series of 81 (mean age 60 years; mean EuroSCORE II, 3.3%) consecutive patients from three European cardiac surgery centers were reviewed. Predictors of a combined endpoint comprising in-hospital death or major complications (including multiple transfusion) were identified with binary logistic regression. Non-parametric estimates of survival were obtained with the Kaplan-Meier method. Predictors of poor late outcomes were established using Cox proportional hazard regression. There were 4 (4.9%) in-hospital deaths. Preoperative central venous pressure > 15 mmHg (p = 0.005) and the use of cardiopulmonary bypass (p = 0.016) were independent predictors of complicated in-hospital course, which occurred in 29 (35.8%) patients. During follow-up (median, 5.4 years), preoperative renal impairment was a predictor of all-cause death (p = 0.0041), cardiac death (p = 0.0008), as well as hospital readmission due to congestive heart failure (p = 0.0037); while partial pericardiectomy predicted all-cause death (p = 0.028) and concomitant cardiac operation predicted cardiac death (p = 0.026), postoperative central venous pressure < 10 mmHg was associated with a low risk both of all-cause and cardiac death (p < 0.0001 for both). Ten-year adjusted survival free of all-cause death, cardiac death, and hospital readmission were 76.9%, 94.7%, and 90.6%, respectively. In high-risk patients with CP, performing pericardiectomy before severe constriction develops and avoiding cardiopulmonary bypass (when possible) could contribute to improving immediate outcomes post-surgery. Complete removal of cardiac constriction could enhance long-term outcomes.

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Surgical experience on chronic constrictive pericarditis in African setting: review of 35 years’ experience in Cote d’Ivoire

Abstract: Based on our experience, CCP surgery can be performed safely with an acceptable hospital mortality and a significant improvement of patients' functional status at long term after surgery.

Cited by 11 publications

References 14 publications

Epidemiology of pericardial diseases in Africa: a systematic scoping review

Epidemiology of pericardial diseases in Africa: a systematic scoping review

Chronic Constrictive Pericarditis (CCP) in Africa: Epidemiology, Etiology, Diagnosis, and Surgical Treatment

Pericardiectomy for constrictive pericarditis: a risk factor analysis for early and late failure

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