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Surgical experience on chronic constrictive pericarditis in African setting: review of 35 years' experience in Cote
Koffi Herve Yangni-Angate1, Yves Tanauh2, Christophe Meneas1
1Department of Cardio-Vascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Cote d'Ivoire.
Insights
This study reviews surgical outcomes for chronic constrictive pericarditis (CCP) in Africa, finding pericardiectomy safe with improved long-term function and acceptable mortality. Key risk factors for early death include advanced NYHA class and mitral regurgitation.
Area of Science:
- Cardiology
- Thoracic Surgery
- Infectious Disease Epidemiology
Background:
- Surgical outcomes for chronic constrictive pericarditis (CCP) are infrequently documented in African populations.
- This study reviews the clinical and surgical outcomes of CCP patients treated in Africa between 1977 and 2012.
- It also identifies risk factors associated with early mortality following pericardiectomy.
Purpose of the Study:
- To evaluate the safety and efficacy of pericardiectomy for chronic constrictive pericarditis in an African cohort.
- To analyze clinical and surgical outcomes, including long-term functional status.
- To determine predictors of early death after pericardiectomy for CCP.
Main Methods:
- A retrospective analysis of 120 patients (72 male, 48 female) diagnosed with CCP, predominantly due to tuberculosis (99%).
- Patients were classified by New York Heart Association (NYHA) functional class (II, III, or IV).
- Pericardiectomy with epicardiectomy and ventricular release was performed, often via median sternotomy.
Main Results:
- Fifteen early deaths (12.5%) occurred, primarily from low cardiac output (12) and hepatic failure (3).
- Significant risk factors for early mortality included NYHA class III/IV, mitral regurgitation, persistent diastolic syndrome, and low cardiac index.
- Survivors showed significant improvements in ventricular diastolic pressures and functional status (NYHA class I/II) at long-term follow-up.
Conclusions:
- Pericardiectomy for CCP in this African cohort is a safe procedure with acceptable hospital mortality.
- The surgery leads to significant long-term functional improvement for patients.
- Identifying and managing risk factors like NYHA class and mitral regurgitation is crucial for improving early survival.
Background:
Surgical experience with chronic constrictive pericarditis (CCP) is rarely documented in Africa; the aim of this study is therefore to review our African experience with CCP from 1977 to 2012 in terms of clinical and surgical outcomes and risk factors of early death after pericardiectomy.
Methods:
This retrospective study is related to 120 patients with CCP; there were 72 men and 48 women with an average age at 28.8±10.4 years standard deviation (SD) (8-51 years). The main etiology was tuberculosis (99%). Symptoms secondary to systemic venous congestion were always present: patient were functionally classified according New York Heart Association (NYHA) functional classification: 63 patients presented in class II NYHA and 57 in class III or IV NYHA. The diagnosis confirmed by surgical report was: sub-acute CCP (n=12; 10%), fibrous CCP (n=36; 30%), calcified CCP (n=72; 60%). A pericardiectomy including an epicardiectomy with a systematic release of the ventricles was carried out in every case. Median sternotomy was frequently performed (n=117; 97.5%).
Results:
Fifteen early deaths (12.5%) were observed, the cause of hospital deaths was due to a low cardiac output (n=12) and to a hepatic failure (n=3). Class III or IV (NYHA) (P=0.01), mitral regurgitation (P<0.05), persistent a diastolic syndrome after surgery (P<0.05) and low cardiac index (CI) (P<0.02) were the important risk factors. Age, size of cardiac X-ray silhouette, right and left ventricular diastolic pressures, ejection fraction (EF), atrial fibrillation and pericardial calcifications had no impact on early survival. The average follow up was 4 years (1-10 years); we lost 22 patients during follow-up. Among survivors, there was no late death; the patients were in class I or II NYHA. Post-operative catheterization evaluation (n=30) shown a significant decrease of the right and left ventricular end-diastolic pressures (P<0.05), of the pulmonary capillary wedge pressure (PCWP) (P<0.05) and of the right atrial pressure (RAP) (P<0.05) and a disappearance of the lack of ventricular diastolic distensibility.
Conclusions:
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.
