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Pericardectomy for chronic constrictive pericarditis: risks and outcome
T Tirilomis1, S Unverdorben, J von der Emde
1Department of Cardiac Surgery, University Hospital, Erlangen, Germany.
Insights
Pericardectomy for constrictive pericarditis offers long-term survival, with improved functional status post-surgery. Preoperative NYHA class IV and specific clinical factors predict poorer outcomes.
Area of Science:
- Cardiology
- Thoracic Surgery
Background:
- Chronic constrictive pericarditis significantly impacts cardiac function and patient quality of life.
- Pericardectomy is a surgical option for managing this condition.
Purpose of the Study:
- To evaluate the long-term outcomes and survival rates following pericardectomy for chronic constrictive pericarditis.
- To identify preoperative predictors of mortality and morbidity.
Main Methods:
- A retrospective analysis of 71 consecutive patients undergoing pericardectomy between 1970 and 1990.
- Data collection included preoperative New York Heart Association (NYHA) classification, operative approach, early mortality, and long-term follow-up (average 11 years).
Main Results:
- Early mortality was 5.6%, with all early deaths occurring in female patients classified as NYHA class IV preoperatively.
- Actuarial survival rates at 20 years were 65.8%.
- Negative predictors for survival included preoperative NYHA class IV, low-voltage ECG, ascites, dyspnea at rest, and hyperbilirubinemia.
Conclusions:
- Pericardectomy can lead to significant long-term survival and improved functional capacity in patients with chronic constrictive pericarditis.
- Identifying high-risk patients preoperatively is crucial for optimizing surgical outcomes.
Abstract:
From 1970 to 1990, 71 consecutive patients (51 men and 20 women) had pericardectomy for chronic constrictive pericarditis. The mean age was 44.2 +/- 16.1 years. In the preoperative state 2.8% were in NYHA class I, 18.3% in II, 43.6% in III and 35.2% in IV. The operative approach was median sternotomy in 93% and left anterolateral thoracotomy in 7%. The early mortality rate (within 30 days after operation) was 5.6%. All four early deaths were female (P < 0.001), in the preoperative state the patients were classified as NYHA class IV (P < 0.01). These patients had a significantly higher preoperative mean right atrial pressure then survivors (21.5 +/- 8.5 mmHg vs 13.6 +/- 5.6 mmHg, P < 0.005). Follow-up was obtained for 65 patients (91.5%) and averaged 11 +/- 5.8 years (the longest period was 21.5 years). Actuarial survival at 5, 10, 15 and 20 years for all patients was 84.6% +/- 4.5%, 80.1% +/- 5.3%, 70.5% +/- 6.9% and 65.8% +/- 7.9%, respectively. In the preoperative state 10 of the 12 late deaths (83%) were classified NYHA class IV and the remaining ones class III. Of the 49 patients alive 23% belong to NYHA class I, 42% to II and 35% to III; none is in class IV. Negative predictors of survival were found to be preoperative NYHA class IV (P < 0.01), low-voltage electrocardiogram (ECG) (P < 0.01), ascites (P < 0.01), dyspnea at rest (P < 0.05) and hyperbilirubinemia (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)