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Total Pericardiectomy Using a Modified Left Anterolateral Thoracotomy Without Cardiopulmonary Bypass
Ujjwal Kumar Chowdhury1, Niwin George1, Sukhjeet Singh1
1Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India.
Insights
Total pericardiectomy for constrictive pericarditis offers excellent survival rates and improved heart function. This minimally invasive approach shows reduced mortality and low cardiac output syndrome, leading to superior long-term hemodynamic benefits.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- Chronic constrictive pericarditis poses significant challenges to cardiac function.
- Surgical intervention, specifically total pericardiectomy, is a treatment option.
- Evaluating the outcomes of this procedure is crucial for patient management.
Purpose of the Study:
- To assess the short- and long-term results of total pericardiectomy.
- To evaluate the impact of the procedure on low cardiac output, intracardiac pressures, survival, and reoperations.
- To determine the efficacy of a modified left anterolateral thoracotomy without cardiopulmonary bypass.
Main Methods:
- A cohort of 127 patients underwent radical total pericardiectomy.
- The procedure utilized a modified left anterolateral thoracotomy.
- No cardiopulmonary bypass was employed during the surgery.
Main Results:
- Operative and late mortality rates were low (3.1% and 1.6%).
- Postoperative low cardiac output occurred in 24.4% of patients, with no reoperations needed.
- Long-term follow-up (median 99 months) showed 97.6% survival and improved New York Heart Association class.
Conclusions:
- Total pericardiectomy is linked to reduced perioperative and late mortality.
- The procedure decreases the incidence of low cardiac output syndrome.
- Significant long-term advantages include superior hemodynamic function.
Background:
We sought to ascertain the short- and long-term results of total pericardiectomy for chronic constrictive pericarditis using a modified left anterolateral thoracotomy without cardiopulmonary bypass on postoperative low cardiac output, normalization of intracardiac pressures, survival, and reoperations.
Methods:
Between January 2005 and December 2019 a series of 127 consecutive patients (91 male patients) between ages 4 and 72 years (median, 25 years; interquartile range, 18-38) underwent radical total pericardiectomy using a modified left anterolateral thoracotomy without cardiopulmonary bypass.
Results:
Operative and late mortalities were 3.1% and 1.6%, respectively. Thirty-one patients (24.4%) had postoperative low cardiac output, and none required reoperations. At a median follow-up of 99 months (interquartile range, 56-141) the actuarial survival was 97.6% ± 0.01% months (95% confidence interval, 92.8-99.2). At their last follow-up 113 (93.4%) and 8 (6.6%) survivors were in New York Heart Association class I and II, respectively.
Conclusions:
Total pericardiectomy is associated with lower perioperative and late mortality and decreased low cardiac output syndrome and confers significant long-term advantage of superior hemodynamics.
