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Re-pericardiectomy for recurrent chronic constrictive pericarditis: left anterolateral thoracotomy is a better
Ling Yunfei1, Li Tao1, Qian Yongjun2
1Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guoxuexiang 37th, 610041, Chengdu, Sichuan, People's Republic of China.
Insights
For recurrent constrictive pericarditis, left thoracotomy pericardiectomy offers similar NYHA status improvement as median sternotomy but with fewer wound infections. This approach may be safer for reoperation, avoiding sternal complications.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- Pericardiectomy is the definitive treatment for constrictive pericarditis.
- Reoperative pericardiectomy for recurrent cases remains controversial regarding optimal surgical approach.
Purpose of the Study:
- To compare outcomes of reoperative pericardiectomy for recurrent constrictive pericarditis using median sternotomy versus left anterolateral thoracotomy.
- To determine the preferred surgical approach for recurrent constrictive pericarditis.
Main Methods:
- Retrospective analysis of 24 patients with recurrent constrictive pericarditis undergoing reoperation between 2003 and 2015.
- Surgical approach (median sternotomy or left anterolateral thoracotomy) determined by surgeon preference.
- Data collected from case notes, comparing perioperative outcomes and functional status.
Main Results:
- Both surgical approaches showed similar mortality rates (12.5%) and significant improvement in New York Heart Association (NYHA) functional class.
- Left anterolateral thoracotomy had a higher rate of pulmonary infection (50% vs. 25%), while median sternotomy had more wound infections (18.8% vs. 12.5%).
- NYHA class improved significantly from a mean of 3.3-3.4 to 1.8-1.9 in both groups (P < 0.001).
Conclusions:
- Left thoracotomy pericardiectomy can be performed safely without cardiopulmonary bypass (CPB) in recurrent constrictive pericarditis.
- This approach avoids life-threatening sternal infections and achieves comparable NYHA functional status improvement to median sternotomy.
- Left thoracotomy may be a preferred approach for reoperative pericardiectomy due to a potentially lower risk of severe wound complications.
Background:
Pericardiectomy is the final treatment for constrictive pericarditis. However, this greatest surgical approach is still very controversial. This study pursued to assess the outcomes in patients with recurrent chronic constrictive pericarditis undergoing reoperated pericardiectomy via median sternotomy versus left anterolateral thoracotomy and to explain which surgical approaches might be better for recurrent chronic constrictive pericarditis.
Methods:
A total of 24 patients were identified with recurrent chronic constrictive pericarditis and underwent reoperation with pericardiectomy between July 2003 and July 2015. The decision for this surgical approach was mainly dependent on the operating surgeon's preference. Out of 20 patients, 16 patients underwent pericardiectomy via median sternotomy and 8 patients via left anterolateral thoracotomy pericardiectomy. Their data were obtained retrospectively from the case notes.
Results:
Both groups of patients were similar in age, gender between two operations, and also in peripheral venous pressure, cardiac rhythm and New York Heart Association (NYHA) class distribution. The mortality rates were similar in both groups with one death (12.5%) due to low cardiac output syndrome in the left anterolateral thoracotomy group and two deaths (12.5%) in the median sternotomy group. All the deaths were associated with cardiac complications and happened in the perioperative period. NYHA functional class status enhanced in most of the patients. Patients in both groups had a similar and significant improvement in their NYHA status that improved from 3.4 ± 0.7 to 1.8 ± 0.1 (P = 0.001) in the left anterolateral thoracotomy group and reduced from 3.3 ± 0.6 to 1.9 ± 0.4 (P = 0.001) in the median sternotomy group. There was a significantly greater rate of pulmonary infection in the thoracotomy group than in the median sternotomy group (50% versus 25%, P = 0.02). Nevertheless, there was a significantly greater occurrence of wound infections in the median sternotomy group in 3 patients versus in one patient of the left anterolateral thoracotomy group (18.8% versus 12.5%, P = 0.02).
Conclusions:
Left thoracotomy incision was preferred to sternotomy in the current setting of this situation and was done safely without CPB. It avoided life-threatening sternal infection and it also has showed an equal as well las significant enhancement of NYHA status of the patients.
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