Surgical Treatment of Constrictive Pericarditis

Abstract

Introduction The mainstay of the treatment of constrictive pericarditis is pericardiectomy. However, surgery is associated with high early morbidity and mortality and low long-term survival. The aim of this study is to describe our series of pericardiectomies performed over 30 years. Methods A descriptive, observational, and retrospective analysis of all pericardiectomies performed at the Institute of Cardiology and Cardiovascular Surgery of the Favaloro Foundation was performed. Results A total of 45 patients underwent pericardiectomy between June 1992 and June 2022, mean age was 52 years (standard deviation ± 13.9 years), and 73.3% were men. Idiopathic constrictive pericarditis was the most prevalent (46.6%). The variables significantly associated with prolonged hospitalization were preoperative advanced functional class (incidence of 38.4%, P<0.04), persistent pleural effusion (incidence of 81.8%, P<0.01), and although there was no statistical significance with the use of cardiopulmonary bypass, a trend in this association is evident (P<0.07). We found that 100% of the patients with an onset of symptoms greater than six months had a prolonged hospital stay. In-hospital mortality was 6.6%, and 30-day mortality was 8.8%. The preserved functional class is 17 times more likely to improve their symptomatology after pericardiectomy (odds ratio 17, 95% confidence interval 2.66-71; P<0.05). Conclusion Advanced functional class at the time of pericardiectomy is the variable most strongly associated with mortality and prolonged hospitalization. Onset of the symptoms greater than six months is also a poor prognostic factor mainly associated with prolonged hospitalization; based on these data, we strongly support the recommendation of early intervention.

Pericardiectomy for Constrictive Pericarditis with or without Cardiopulmonary Bypass

“…In cases of purulent pericarditis and effusive-constricted constrictive pericardial disease, the left anterior lateral thoracotomy approach should be preferred, as there is a risk of both empyema and sternal infection. [26][27][28][29] Despite successful pericardiectomy, residual and prolonged constriction, or myocardial atrophy following myocardial processes can lead to long-term heart failure. The causes of death are multiple organ failure, heart failure, and respiratory insufficiency.…”

“…The causes of death are multiple organ failure, heart failure, and respiratory insufficiency. 28,[30][31][32]…”

The Important Role of Preoperative D-Dimer in Constrictive Pericarditis

“…5 Pericardiectomy is a definitive treatment option, but surgical resection of pericardium carries a high risk of postoperative mortality with reported rate up to 17.6%. [6][7][8][9] Given the difficulty of predicting precise prognosis in constrictive pericarditis, some easily accessible indicators, such as laboratory indicators, should be considered as predictors for a more accurate prognosis evaluation. Coagulation indicators are frequently screened preoperatively and taken into account during perioperative planning.…”