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Published on: March 26, 2018
Surgical approach for pericardiectomy: a comparative study between median sternotomy and left anterolateral
Ravindranath Tiruvoipati1, Ramvatu Devasingh Naik, Mahmoud Loubani
1Department of Cardiothoracic Surgery, Osmania General Hospital, Hyderabad, Andhra Pradesh, India. travindranath@hotmail.com
Insights
Pericardiectomy effectively treats constrictive pericarditis, with similar mortality rates for both median sternotomy and left anterolateral thoracotomy approaches. Both surgical methods significantly improve shortness of breath, with no significant difference between them.
Area of Science:
- Cardiology
- Thoracic Surgery
- Medical Research
Background:
- Constrictive pericarditis requires pericardiectomy for definitive treatment.
- The optimal surgical approach for pericardiectomy is debated.
- Previous studies have not definitively established the superiority of one surgical technique over another.
Purpose of the Study:
- To compare the outcomes of pericardiectomy performed via median sternotomy versus left anterolateral thoracotomy.
- To evaluate differences in mortality, functional status improvement, and postoperative complications between the two surgical approaches.
Main Methods:
- A retrospective study comparing 36 patients with constrictive pericarditis undergoing pericardiectomy between 1995 and 2001.
- Patients were divided into two groups: 15 undergoing median sternotomy and 21 undergoing left anterolateral thoracotomy.
- Outcomes including mortality, New York Heart Association (NYHA) functional status, and complications were assessed postoperatively.
Main Results:
- Mortality rates were comparable between the thoracotomy (14.2%) and sternotomy (13.3%) groups.
- Both groups showed significant improvement in NYHA status (thoracotomy: 3.0 to 1.6; sternotomy: 2.9 to 1.5), with no significant difference between approaches (P=0.63).
- Thoracotomy was associated with a higher incidence of wound infections (23.8% vs. 6.6%) and pulmonary complications (23.8% vs. 13.3%), though not statistically significant.
Conclusions:
- Pericardiectomy significantly improves NYHA status in patients with constrictive pericarditis, regardless of surgical approach.
- Both median sternotomy and left anterolateral thoracotomy offer similar mortality rates for pericardiectomy.
- While not statistically significant, thoracotomy showed a trend towards increased infectious and pulmonary complications.
Abstract:
Pericardiectomy is the definitive treatment for constrictive pericarditis but the best surgical approach remains controversial. In this study we compared the results of pericardiectomy performed on 36 patients with constrictive pericarditis between 1995 and 2001. Pericardiectomy was performed by median sternotomy in 15 patients and by left anterolateral thoracotomy in 21 patients. All patients were reviewed at 6 weeks post operatively. Both groups of patients were similar in age, sex distribution, NYHA shortness of breath status, aetiology, presenting symptoms and duration of symptoms. Mortality was similar in the two groups with three deaths (14.2%) in the thoracotomy group and two deaths (13.3%) in the median sternotomy group. NYHA status improved in both thoracotomy (3.0+/-0.8 to 1.6+/-0.7; P=3.3x10(-6)) and median sternotomy (2.9+/-0.7 to 1.5+/-0.6; P=2.8x10(-5)) groups. The degree of improvement was not significant between the two groups (P=0.63). In addition ionotropic support and postoperative hospital stay were similar between the two groups. There was a higher incidence of wound infections (23.8 versus 6.6%; P=0.13) and pulmonary complications (23.8 versus 13.3%; P=0.33) associated with thoracotomy. In conclusion pericardiectomy improves NYHA status in all patients and mortality rates are similar in both the approaches.
