Pericardiectomy for Constrictive Pericarditis: An Institution's 21 Years Experience
24 April 2017
16 June 2017
06 August 2017 (online)
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.
- 1 Miranda WR, Oh JK. Constrictive pericarditis: a practical clinical approach. Prog Cardiovasc Dis 2017; 59 (04) 369-379
- 2 Syed FF, Schaff HV, Oh JK. Constrictive pericarditis--a curable diastolic heart failure. Nat Rev Cardiol 2014; 11 (09) 530-544
- 3 Haley JH, Tajik AJ, Danielson GK, Schaff HV, Mulvagh SL, Oh JK. Transient constrictive pericarditis: causes and natural history. J Am Coll Cardiol 2004; 43 (02) 271-275
- 4 Khandaker MH, Schaff HV, Greason KL. , et al. Pericardiectomy vs medical management in patients with relapsing pericarditis. Mayo Clin Proc 2012; 87 (11) 1062-1070
- 5 Avgerinos D, Rabitnokov Y, Worku B, Neragi-Miandoab S, Girardi LN. Fifteen-year experience and outcomes of pericardiectomy for constrictive pericarditis. J Card Surg 2014; 29 (04) 434-438
- 6 Gillaspie EA, Stulak JM, Daly RC. , et al. A 20-year experience with isolated pericardiectomy: analysis of indications and outcomes. J Thorac Cardiovasc Surg 2016; 152 (02) 448-458
- 7 Sellors TH. Constrictive pericarditis. Br J Surg 1946; 33: 215-230 . Available at http://onlinelibrary.wiley.com/doi/10.1002/bjs.18003313103/abstract . Accessed June 2017
- 8 Brauer L. Die Kardiolysis und ihre Indikationen. Arch Klin Chir 1903; 71: 258
- 9 Volhard F, Schmieden V. Über Erkennung und Behandlung der Umklammerung des Herzens durch schwielige Perikarditis. Klin Wochenschr 1923; 2 (01) 5-9
- 10 Vistarini N, Chen C, Mazine A. , et al. Pericardiectomy for constrictive pericarditis: 20 years of experience at the Montreal Heart Institute. Ann Thorac Surg 2015; 100 (01) 107-113
- 11 Bertog SC, Thambidorai SK, Parakh K. , et al. Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy. J Am Coll Cardiol 2004; 43 (08) 1445-1452
- 12 Beckmann E, Ismail I, Cebotari S. , et al. Right-sided heart failure and extracorporeal life support in patients undergoing pericardiectomy for constrictive pericarditis: a risk factor analysis for adverse outcome. Eur J Cardiothorac Surg 2015; 48 (06) e110-116
- 13 Busch C, Penov K, Amorim PA. , et al. Risk factors for mortality after pericardiectomy for chronic constrictive pericarditis in a large single-centre cohort. Eur J Cardiothorac Surg 2015; 48 (06) e110-e116