Thorac cardiovasc Surg
DOI: 10.1055/s-0037-1604303
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Pericardiectomy for Constrictive Pericarditis: An Institution's 21 Years Experience

Leopold Rupprecht1, Christina Putz1, Bernhard Flörchinger1, York Zausig2, Daniele Camboni1, Bernhard Unsöld3, Christof Schmid1
  • 1Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
  • 2Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
  • 3Department of Cardiology, University Medical Center Regensburg, Regensburg, Germany
Further Information

Publication History

24 April 2017

16 June 2017

Publication Date:
06 August 2017 (eFirst)

Abstract

Background The aim of this retrospective study was to evaluate our experience with the surgical pericardiectomy procedure for patients suffering from isolated severe constrictive pericarditis.

Methods From 1995 to 2016, 39 patients underwent isolated pericardiectomy for constrictive pericarditis. Fifteen patients were excluded because of concomitant surgery. There were 31 male (79.5%) patients and 8 female (20.5%) patients, 28 to 76 years old (mean, 56.6 ± 13.6 years). The underlying etiologies were idiopathic pericarditis (74.5%), infection (10%), rheumatic disorders (8%), status post cardiac surgery (2.5%), tuberculosis (2.5%), and status post mediastinal irradiation (2.5%).

Results Pericardiectomy was performed through midline sternotomy in all cases. Sixteen patients (41%) underwent pericardiectomy electively employing cardiopulmonary bypass with the heart beating, and 23 patients (59%) had surgery without extracorporeal circulation (ECC). The overall 30-day mortality rate was 50% if cardiopulmonary bypass was used (13.8% since 2007). If surgery was performed without a heart–lung machine, mortality was 0%. On-pump patients had a significantly longer intensive care unit (ICU) stay (12 ± 9 vs. 4 ± 4 days, p = 0.013). Likewise, the duration of mechanical ventilation was much longer (171 ± 246 vs. 21 ± 40 hours, p = 0.04). The hospital stay was comparable with 28 ± 10 and 24 ± 18 days (p = 0.21).

Conclusion The present study demonstrates that pericardiectomy, without the use of cardiopulmonary bypass as treatment for constrictive pericarditis, is a safe procedure with an excellent outcome in critically ill patients.