Anterior Pericardiectomy for Postinfective Constrictive Pericarditis: Intermediate-Term Outcomes

Area of Science:

• Cardiology
• Thoracic Surgery
• Infectious Diseases

Background:

• Constrictive pericarditis, often post-tubercular, is common in developing nations.
• Pericardiectomy is the primary treatment but carries significant risks.

Purpose of the Study:

• To evaluate the efficacy and outcomes of anterior pericardiectomy for constrictive pericarditis.
• To identify predictors of surgical outcomes in patients undergoing pericardiectomy.

Main Methods:

• A retrospective analysis of 130 pericardiectomies performed between 2003 and 2013.
• Patients were predominantly male, young, and in advanced New York Heart Association functional classes (III/IV).
• The majority of cases were of presumed tubercular origin, with many having prior antitubercular treatment.

Main Results:

• Anterior pericardiectomy was performed, with cardiopulmonary bypass needed in only 3.8% of cases.
• Early mortality was 7.69%, with significant rates of prolonged ventilation (16.92%) and renal dysfunction (23.84%).
• Post-surgery, 85% of patients improved to New York Heart Association functional class I or II within 12 months, with no recurrence of constriction.

Conclusions:

• Anterior pericardiectomy is a sufficient surgical approach for constrictive pericarditis of infective origin.
• Preoperative factors like low ejection fraction, atrial fibrillation, and poor functional class are associated with adverse surgical outcomes.