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Duarte NF, de Aguiar Trigueirinho Ferreira S, Filho DAA, Vidal CHL, Lima RS, Martins AVV, Castro RO, de Assis ACR, Soares PR, Scudeler TL. Right ventricular dysfunction after pericardiectomy for tuberculous constrictive pericarditis: A case report. Clin Case Rep 2024; 12:e8899. [PMID: 38799540 PMCID: PMC11116479 DOI: 10.1002/ccr3.8899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 04/22/2024] [Accepted: 04/28/2024] [Indexed: 05/29/2024] Open
Abstract
Key Clinical MessageThis case report provides a peculiar case of tuberculous constrictive pericarditis (TCP) who presented with right ventricular dysfunction after pericardiectomy. Right ventricular dysfunction is one of the main postoperative complications after pericardiectomy. Rapid and accurate identification of right ventricular dysfunction confirmed by transthoracic echocardiography (TTE), associated with the rapid initiation of diuretics and inotropic therapy is necessary for the patient's complete recovery.AbstractTCP is a condition characterized by chronic inflammation and fibrosis of the pericardium. Pericardiectomy is the standard treatment for patients with constrictive pericarditis and persistent symptoms. One possible surgical complication is right ventricle (RV) failure. We report a case of a 44‐year‐old man who developed RV failure after pericardiectomy for TCP. A 41‐year‐old man with no medical history was referred to our hospital due to progressive dyspnea associated with edema of the lower limbs and significant weight loss (30 kg) over the past 5 months. TTE revealed significant pericardial thickening and mild pericardial effusion with normal RV function. Chest X‐ray showed moderate bilateral pleural effusion. The patient underwent pericardiectomy and bilateral pleural drainage. Histopathological examination showed tuberculosis granulomas with caseous necrosis, and antituberculosis medication was initiated. Postoperative TTEs showed normal RV function and mild pericardial thickening. The patient was discharged home after successful postoperative recovery. Three weeks later, the patient was admitted to the emergency department with dyspnea and hypoxemia. TTE revealed RV systolic dysfunction. Chest CT showed a recurrence of moderate pleural effusion, this time loculated, with restrictive atelectasis of the adjacent lung parenchyma. Diuretics and inotropic therapy were initiated, and the patient underwent lung decortication after confirmation of tuberculous empyema. The patient experienced significant clinical improvement. TTE before discharge showed a decreased RV chamber size with improved RV systolic function. The patient was discharged in a stable condition 30 days after admission with a low dose of oral furosemide. Four months after discharge, he remained asymptomatic with good functional status. Pericardiectomy for TCP may carry the risk of developing RV dysfunction. Furthermore, TCP itself may be associated with other complications, such as empyema. We emphasize the importance of conducting a thorough clinical evaluation for patients with TCP, particularly those undergoing pericardiectomy, to mitigate potential adverse outcomes.
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Affiliation(s)
- Natânia Ferreira Duarte
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | | | - Daniel Abdalla Added Filho
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Carlos Henrique Lopes Vidal
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Roger Sales Lima
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Ana Vitória Vitoreti Martins
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Rafael Oliveira Castro
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Arthur Cicupira Rodrigues de Assis
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Paulo Rogério Soares
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Thiago Luis Scudeler
- Emergency Department of Instituto do Coração (InCor)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
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Li B, Dong C, Pan G, Liu R, Tong M, Xu J, Liu S. Outcomes and Risk Factors Associated with Pericardiectomy in Patients with Constrictive Pericarditis: A Retrospective Study from China. Ann Thorac Cardiovasc Surg 2024; 30:24-00036. [PMID: 38811208 PMCID: PMC11163141 DOI: 10.5761/atcs.oa.24-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/28/2024] [Indexed: 05/31/2024] Open
Abstract
PURPOSE Pericardiectomy is the definitive treatment option for constrictive pericarditis and is associated with a high prevalence of morbidity and mortality. However, information on the associated outcomes and risk factors is limited. We aimed to report the mid-term outcomes of pericardiectomy from a single center in China. METHODS We retrospectively reviewed data collected from patients who underwent pericardiectomy at our institute from April 2018 to January 2023. RESULTS Eighty-six consecutive patients (average age, 46.1 ± 14.7 years; 68.6 men) underwent pericardiectomy through midline sternotomy. The most common etiology was idiopathic (n = 60, 69.8%), and 82 patients (95.3%) were in the New York Heart Association function class III/IV. In all, 32 (37.2%) patients underwent redo sternotomies, 36 (41.9%) underwent a concomitant procedure, and 39 (45.3%) required cardiopulmonary bypass. The 30-day mortality rate was 5.8%, and the 1-year and 5-year survival rates were 88.3% and 83.5%, respectively. Multivariable analysis revealed that preoperative mitral insufficiency (MI) ≥moderate (hazard ratio [HR], 6.435; 95% confidence interval [CI] [1.655-25.009]; p = 0.007) and partial pericardiectomy (HR, 11.410; 95% CI [3.052-42.663]; p = 0.000) were associated with increased 5-year mortality. CONCLUSION Pericardiectomy remains a safe operation for constrictive pericarditis with optimal mid-term outcomes.
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Affiliation(s)
- Bin Li
- Cardiac Surgery Department, Peking University International Hospital, Beijing, China
| | - Chao Dong
- Cardiac Surgery Department, Peking University International Hospital, Beijing, China
| | - Guangyu Pan
- Cardiac Surgery Department, Peking University International Hospital, Beijing, China
| | - Ruofan Liu
- Cardiac Surgery Department, Peking University International Hospital, Beijing, China
| | - Minghui Tong
- Cardiac Surgery Department, Peking University International Hospital, Beijing, China
| | - Jianping Xu
- Cardiac Surgery Department, Peking University International Hospital, Beijing, China
| | - Shen Liu
- Cardiac Surgery Department, Peking University International Hospital, Beijing, China
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Ceriani E, Vittorio B, Samuele P, Rizzi G, Torzillo D. Look at the moon not (only) at the fingers. Intern Emerg Med 2024; 19:139-144. [PMID: 37486572 DOI: 10.1007/s11739-023-03367-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/03/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Elisa Ceriani
- Department of Internal Medicine, Ospedale Luigi Sacco, Via GB Grassi 74, 20157, Milano, Italy.
| | - Borroni Vittorio
- Department of Internal Medicine, Ospedale Luigi Sacco, Via GB Grassi 74, 20157, Milano, Italy
| | - Pentiricci Samuele
- Cardiovascular Department, Cardiosurgery Unit, Ospedali Riuniti Di Bergamo, Bergamo, Italy
| | - Giulia Rizzi
- Department of Internal Medicine, Ospedale Luigi Sacco, Via GB Grassi 74, 20157, Milano, Italy
| | - Daniela Torzillo
- Department of Internal Medicine, Ospedale Luigi Sacco, Via GB Grassi 74, 20157, Milano, Italy
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Moros D, Zaki A, Tong MZY. Surgical Approaches for Pericardial Diseases: What Is New? Curr Cardiol Rep 2023; 25:1705-1713. [PMID: 37938424 DOI: 10.1007/s11886-023-01986-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the evolving techniques and approaches for pericardiectomy, with a focus on the use of cardiopulmonary bypass (CPB) and the extent of radical pericardial resection. The review aims to highlight the benefits and considerations associated with these modifications in radical pericardiectomy. RECENT FINDINGS Recent studies have demonstrated that the use of CPB during pericardiectomy does not increase procedural risk or negatively impact survival. In fact, it has been shown to contribute to a more radical resection and improve postoperative outcomes, which is associated with less recurrence and better survival. The review emphasizes the importance of radical pericardiectomy and the use of CPB in achieving successful outcomes. Radical resection of the pericardium, facilitated by CPB, helps minimize the risk of recurrent constrictions and the need for reinterventions. The findings highlight the correlation between postoperative outcomes and survival, further supporting the use of CPB.
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Affiliation(s)
- David Moros
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Anthony Zaki
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Michael Zhen-Yu Tong
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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Shell D. The role of cardiac surgery in radiation-associated heart disease: a scoping review. Gen Thorac Cardiovasc Surg 2023; 71:629-638. [PMID: 37166740 DOI: 10.1007/s11748-023-01939-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/04/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Thoracic irradiation is an important tool in the treatment of breast cancer, non-Hodgkin's lymphoma, and other cancers of the chest. The heart is commonly involved in these radiation fields, and young patients can present with severe cardiac pathologies requiring surgical intervention. However, this population poses a high surgical risk due to involvement of mediastinal tissues, and there are no consensus guidelines on best practice management. AIM This review aims to summarise the current experience of surgical correction of radiation-associated heart disease. We explore outcomes, technique modifications and alternative therapies for the three primary procedures performed: coronary artery bypass grafting, valvular intervention and pericardiectomy. METHODS OVID Medline and PubMed databases were comprehensively searched to identify all studies involving surgery in patients with prior chest radiotherapy. All relevant studies within the past 25 years have been discussed. CONCLUSION Irradiated patients have heightened peri-operative risk, but other than redo surgery, these operations are not as treacherous as once thought. Involvement of all layers of the heart, especially the myocardium, is such that long-term mortality suffers despite optimal surgical correction. The goal of surgery in this cohort should be for a quick and safe operation, rather than a technically difficult procedure aimed at longevity.
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Affiliation(s)
- Daniel Shell
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, St Vincent's Health Australia, Melbourne, Australia.
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Barua A, Cosbey L, Jeeji R, Balacumaraswami L. Early life threatening constrictive pericarditis following off-pump CABG. J Surg Case Rep 2023; 2023:rjad602. [PMID: 37942342 PMCID: PMC10629871 DOI: 10.1093/jscr/rjad602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/10/2023] [Indexed: 11/10/2023] Open
Abstract
We present a unique case of aggressive symptomatic constrictive pericarditis within one month following off pump coronary artery bypass grafting surgery. The patient had a medical history of Hodgkin's lymphoma treated with radiotherapy and chemotherapy 20 years ago. Investigations confirmed constrictive pericardium with patent grafts and good biventricular function. Pericardiectomy was successful with remarkable recovery of symptoms.
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Affiliation(s)
- Anupama Barua
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Newcastle Rd, Stoke-on-Trent ST4 6QG, United Kingdom
| | - Lucy Cosbey
- Department of Radiology, Royal Stoke University Hospital, Newcastle Rd, Stoke-on-Trent ST4 6QG, United Kingdom
| | - Ravish Jeeji
- Department of Cardiothoracic Anaesthesia, Royal Stoke University Hospital, Newcastle Rd, Stoke-on-Trent ST4 6QG, United Kingdom
| | - Lognathen Balacumaraswami
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Newcastle Rd, Stoke-on-Trent ST4 6QG, United Kingdom
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Gallo M, Cresce GD, Favaro A, Hinna Danesi T, Salvador L. Totally Endoscopic Constrictive Pericarditis Treatment: A Case Series. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:97-99. [PMID: 36762792 DOI: 10.1177/15569845231152861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Minimally invasive cardiac surgery has increased in popularity to reduce the morbidity associated with open heart surgery. In this article, a totally endoscopic case series is presented in which anterior pericardiectomy is performed by peripheral femoral arterial and venous cannulation. Right periareoal incision and right submammary incision were used for male and female patients, respectively, to access the heart by the fourth intercostal space.
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Affiliation(s)
- Michele Gallo
- Division of Cardiac Surgery, San Bortolo Hospital, Vicenza, Italy
| | | | | | - Tommaso Hinna Danesi
- Division of Cardiac Surgery, San Bortolo Hospital, Vicenza, Italy.,Department of Cardiac Surgery, University of Cincinnati, OH, USA
| | - Loris Salvador
- Division of Cardiac Surgery, San Bortolo Hospital, Vicenza, Italy
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Oh NA, Hennecken C, Van den Eynde J, Doulamis IP, Avgerinos DV, Kampaktsis PN. Pericardiectomy and Pericardial Window for the Treatment of Pericardial Disease in the Contemporary Era. Curr Cardiol Rep 2022; 24:1619-1631. [PMID: 36029363 DOI: 10.1007/s11886-022-01773-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW To summarize the contemporary practice of pericardiectomy and pericardial window. We discuss the indications, preoperative planning, procedural aspects, postprocedural management, and outcomes of each procedure. RECENT FINDINGS Surgical approaches for the treatment of pericardial disease have been around even before the emergence of cardiopulmonary bypass. Since the forthcoming of cardiopulmonary bypass, there have been significant changes in the epidemiology and diagnostic approach of pericardial diseases as well as advancements in the surgical techniques and perioperative management used in the care of these patients. Pericardiectomy has an average mortality of almost 7% and is typically performed in patients with advanced symptoms from constrictive pericarditis and relatively few comorbidities. Pericardial window is a safe procedure for the treatment of pericardial effusion that can be performed with different approaches.
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Affiliation(s)
- Nicholas A Oh
- Department of Cardiothoracic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Carolyn Hennecken
- Division of Cardiology, New York Presbyterian Hospital, Columbia University Irving Medical Center, 177 Fort Washington Av, New York, NY, 10032, USA
| | - Jef Van den Eynde
- The Johns Hopkins Hospital and School of Medicine, Helen B. Taussig Heart Center, Baltimore, MD, USA
- Department of Cardiovascular Sciences, KU Leuven, Louvain, Belgium
| | - Ilias P Doulamis
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dimitrios V Avgerinos
- Third Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Polydoros N Kampaktsis
- Division of Cardiology, New York Presbyterian Hospital, Columbia University Irving Medical Center, 177 Fort Washington Av, New York, NY, 10032, USA.
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Wang J, Zhang X, Liu X, Pei L, Zhang Y, Yu C, Huang Y. Predictors of low cardiac output after isolated pericardiectomy: an observational study. Perioper Med (Lond) 2022; 11:34. [PMID: 35974413 PMCID: PMC9382721 DOI: 10.1186/s13741-022-00267-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 05/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Low cardiac output is the main cause of perioperative death after pericardiectomy for constrictive pericarditis. We investigated the associated risk factors and consequences. Methods We selected constrictive pericarditis patients undergoing isolated pericardiectomy from January 2013 to January 2021. Postoperative low cardiac output was defined as requiring mechanical circulatory support or more than one inotrope to maintain a cardiac index > 2.2 L •min−1 •m−2 without hypoperfusion, despite adequate filling status. Uni- and multivariable analysis were used to identify factors associated with low cardiac output. Cox regression was used to identify factors associated with length of hospital stay. Results Among 212 patients with complete data, 55 (25.9%) developed low cardiac output within postoperative day 1 (quartiles 1 and 2), which caused seven of the nine perioperative deaths. The rates of atrial arrhythmia, renal dysfunction, hypoalbuminemia, modest-to-severe hyponatremia, and hyperbilirubinemia caused by constrictive pericarditis were 9.4%, 12.3%, 49.1%, 10.4%, and 81.6%. The mean preoperative central venous pressure and cardiac index were 18 ± 5 cmH2O and 1.87 ± 0.45 L•min−1•m−2. Univariable analysis showed that low cardiac output patients had higher rates of atrial arrhythmia (OR 3.32 [1.35, 8.17], P = 0.007), renal dysfunction (OR 4.24 [1.94, 9.25], P < 0.001), hypoalbuminemia (OR 1.99 [1.06, 3.73], P = 0.031) and hyponatremia (OR 6.36 [2.50, 16.20], P < 0.001), greater E peak velocity variation (difference 2.8 [0.7, 5.0], P = 0.011), higher central venous pressure (difference 3 [2,5] cmH2O, P < 0.001) and lower cardiac index (difference − 0.27 [− 0.41, − 0.14] L•min−1•m−2, P < 0.001) than patients without low cardiac output. Multivariable regression showed that atrial arrhythmia (OR 4.04 [1.36, 12.02], P = 0.012), renal dysfunction (OR 2.64 [1.07, 6.50], P = 0.035), hyponatremia (OR 3.49 [1.19, 10.24], P = 0.023), high central venous pressure (OR 1.17 [1.08, 1.27], P < 0.001), and low cardiac index (OR 0.36 [0.14, 0.92], P = 0.032) were associated with low cardiac output (AUC 0.79 [0.72–0.86], P < 0.001). Cox regression analysis showed that hyperbilirubinemia (HR 0.66 [0.46, 0.94], P = 0.022), renal dysfunction (HR 0.51 [0.33, 0.77], P = 0.002), and low cardiac output (HR 0.42 [0.29, 0.59], P < 0.001) were associated with length of hospital stay. Conclusions Early recognition and management of hyponatremia, renal dysfunction, fluid retention, and hyperbilirubinemia may benefit constrictive pericarditis patients after pericardiectomy.
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Affiliation(s)
- Jin Wang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaohong Zhang
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Xingrong Liu
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lijian Pei
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuelun Zhang
- Department of Biostatistics and Epidemiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chunhua Yu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Kumar S, Khubber S, Reyaldeen R, Agrawal A, Cremer PC, Imazio M, Kwon DH, Klein AL. Advances in Imaging and Targeted Therapies for Recurrent Pericarditis: A Review. JAMA Cardiol 2022; 7:975-985. [PMID: 35976625 DOI: 10.1001/jamacardio.2022.2584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Pericarditis is the most common form of pericardial disease. Recurrence of pericarditis affects 15% to 30% of patients after the initial episode of pericarditis. Up to 50% of patients with the first recurrence have additional recurrences. These patients often progress to have colchicine-resistant and corticosteroid-dependent disease. Rapidly evolving cardiac magnetic resonance imaging techniques and novel targeted therapies have paved the way for imaging-guided therapy for recurrent pericarditis. However, the optimal application of these recent advances remains unclear. Observations A search was conducted using the PubMed and Cochrane databases for English-language studies, management guidelines, meta-analyses, and review articles published until April 2022 on recurrent pericarditis. Following the 2015 European Society of Cardiology guidelines for the diagnosis and management of pericardial diseases, new clinical trials and registry data have emerged that demonstrate the efficacy of interleukin-1 blockers in recurrent pericarditis. In addition, new observational data have come to light supporting the use of cardiac magnetic resonance imaging in the diagnosis, risk stratification, and management of such patients. Conclusions and Relevance Advances in imaging and targeted therapies have led to a paradigm shift in the management of recurrent pericarditis. This narrative review summarizes the established and emerging data on the diagnosis and treatment of recurrent pericarditis with special emphasis on the role of cardiac magnetic resonance imaging and interleukin-1 blockers in the current era of tailored therapy for recurrent pericarditis.
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Affiliation(s)
- Sachin Kumar
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shameer Khubber
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Reza Reyaldeen
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ankit Agrawal
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul C Cremer
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Deborah H Kwon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
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Biswal S, Mahapatra RP, Kundu A, Gupta S, Sathia S, Mitra S. Idiopathic Pericardial Ossification Causing Chronic Constrictive Pericarditis. Fetal Pediatr Pathol 2022; 41:480-485. [PMID: 33103518 DOI: 10.1080/15513815.2020.1839150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chronic constrictive pericarditis (CCP) is usually caused by the fibroinflammatory reaction of the visceral and parietal pericardium that encase the heart. The cause of CCP is various including tuberculosis, trauma, prior surgery, radiation, and malignancy. MATERIAL AND METHODS We examined the pericardiectomy specimen of a case of CCP in a 17-year-old boy. RESULTS The histopathology of the pericardium revealed pericardial ossification bony remodeling and hematopoiesis within the intertrabecular marrow spaces. No granulomatous or neoplastic etiology was identified. CONCLUSION Idiopathic pericardial ossification can cause CCP in pediatric patients.
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Affiliation(s)
- Sandhya Biswal
- AIIMS Bhubaneswar, Pathology and Lab Medicine, Bhubaneswar, India
| | | | - Anirban Kundu
- AIIMS Bhubaneswar, Pathology and Lab Medicine, Bhubaneswar, India
| | - Shradha Gupta
- AIIMS Bhubaneswar, Cardiothoracic and Vascular Surgery, Bhubaneswar, India
| | - Siddhartha Sathia
- AIIMS Bhubaneswar, Cardiothoracic and Vascular Surgery, Bhubaneswar, India
| | - Suvradeep Mitra
- AIIMS Bhubaneswar, Pathology and Lab Medicine, Bhubaneswar, India
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Dybowska M, Błasińska K, Gątarek J, Klatt M, Augustynowicz-Kopeć E, Tomkowski W, Szturmowicz M. Tuberculous Pericarditis—Own Experiences and Recent Recommendations. Diagnostics (Basel) 2022; 12:diagnostics12030619. [PMID: 35328173 PMCID: PMC8947333 DOI: 10.3390/diagnostics12030619] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 02/26/2022] [Indexed: 02/04/2023] Open
Abstract
Tuberculous pericarditis (TBP) accounts for 1% of all forms of tuberculosis and for 1–2% of extrapulmonary tuberculosis. In endemic regions, TBP accounts for 50–90% of effusive pericarditis; in non-endemic, it only accounts for 4%. In the absence of prompt and effective treatment, TBP can lead to very serious sequelae, such as cardiac tamponade, constrictive pericarditis, and death. Early diagnosis of TBP is a cornerstone of effective treatment. The present article summarises the authors’ own experiences and highlights the current status of knowledge concerning the diagnostic and therapeutic algorithm of TBP. Special attention is drawn to new, emerging molecular methods used for confirmation of M. tuberculosis infection as a cause of pericarditis.
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Affiliation(s)
- Małgorzata Dybowska
- Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland; (W.T.); (M.S.)
- Correspondence:
| | - Katarzyna Błasińska
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland;
| | - Juliusz Gątarek
- Department of Thoracic Surgery, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland;
| | - Magdalena Klatt
- Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland; (M.K.); (E.A.-K.)
| | - Ewa Augustynowicz-Kopeć
- Department of Microbiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland; (M.K.); (E.A.-K.)
| | - Witold Tomkowski
- Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland; (W.T.); (M.S.)
| | - Monika Szturmowicz
- Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland; (W.T.); (M.S.)
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Klein A, Cremer P, Kontzias A, Furqan M, Forsythe A, Crotty C, Lim-Watson M, Magestro M. Clinical Burden and Unmet Need in Recurrent Pericarditis: A Systematic Literature Review. Cardiol Rev 2022; 30:59-69. [PMID: 32956167 PMCID: PMC8812421 DOI: 10.1097/crd.0000000000000356] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Inflammation of the pericardium (pericarditis) is characterized by excruciating chest pain. This systematic literature review summarizes clinical, humanistic, and economic burdens in acute, especially recurrent, pericarditis, with a secondary aim of understanding United States treatment patterns and outcomes. Short-term clinical burden is well characterized, but long-term data are limited. Some studies report healthcare resource utilization and economic impact; none measure health-related quality-of-life. Pericarditis is associated with infrequent but potentially life-threatening complications, including cardiac tamponade (weighted average: 12.7% across 10 studies), constrictive pericarditis (1.84%; 9 studies), and pericardial effusion (54.7%; 16 studies). There are no approved pericarditis treatments; treatment guidelines, when available, are inconsistent on treatment course or duration. Most recommend first-line use of conventional treatments, for example, nonsteroidal antiinflammatory drugs with or without colchicine; however, 15-30% of patients experience recurrence. Second-line therapy may involve conventional therapies plus long-term utilization of corticosteroids, despite safety issues and the difficulty of tapering or discontinuation. Other exploratory therapies (eg, azathioprine, immunoglobulin, methotrexate, anakinra) present steroid-sparing options, but none are supported by robust clinical evidence, and some present tolerability challenges that may impact adherence. Pericardiectomy is occasionally pursued in treatment-refractory patients, although data are limited. This lack of an evidence-based treatment pathway for patients with recurrent disease is reflected in readmission rates, for example, 12.2% at 30 days in 1 US study. Patients with continued recurrence and inadequate treatment response need approved, safe, accessible treatments to resolve pericarditis symptoms and reduce recurrence risk without excessive treatment burden.
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Affiliation(s)
- Allan Klein
- From the Department of Cardiovascular Medicine, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Paul Cremer
- From the Department of Cardiovascular Medicine, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Apostolos Kontzias
- Department of Medicine, Division of Rheumatology, Allergy and Immunology, Center of Autoinflammatory Diseases, State University of New York Stonybrook, New York, NY
| | - Muhammad Furqan
- From the Department of Cardiovascular Medicine, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
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Wang J, Yu C, Zhang Y, Huang Y. A Prediction Model for Acute Kidney Injury After Pericardiectomy: An Observational Study. Front Cardiovasc Med 2022; 9:790044. [PMID: 35224038 PMCID: PMC8873385 DOI: 10.3389/fcvm.2022.790044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/19/2022] [Indexed: 12/18/2022] Open
Abstract
Objectives Acute kidney injury is a common complication after pericardiectomy for constrictive pericarditis, which predisposes patients to worse outcomes and high medical costs. We aimed to investigate potential risk factors and consequences and establish a prediction model. Methods We selected patients with constrictive pericarditis receiving isolated pericardiectomy from January 2013 to January 2021. Patients receiving concomittant surgery or repeat percardiectomy, as well as end-stage of renal disease were excluded. Acute kidney injury was diagnosed and classified according to the KDIGO criteria. Clinical features were compared between patients with and without postoperative acute kidney injury. A prediction model was established based on multivariable regression analysis. Results Among two hundred and eleven patients, ninety-five (45.0%) developed postoperative acute kidney injury, with fourty-three (45.3%), twenty-eight (29.5%), and twenty-four (25.3%) in mild, moderate and severe stages, respectively. Twenty-nine (13.7%) patients received hemofiltration. Nine (4.3%) patients died perioperatively and were all in the acute kidney injury (9.5%) group. Eleven (5.2%) patients were considered to have chronic renal dysfunction states at the 6-month postoperative follow-up, and eight (72.7%) of them experienced moderate to severe stages of postoperative acute kidney injury. Univariable analysis showed that patients with acute kidney injury were older (difference 8 years, P < 0.001); had higher body mass index (difference 1.68 kg·m−2, P = 0.002); rates of smoking (OR = 2, P = 0.020), hypertension (OR = 2.83, P = 0.004), and renal dysfunction (OR = 3.58, P = 0.002); higher central venous pressure (difference 3 cm H2O, P < 0.001); and lower cardiac index (difference −0.23 L·min−1·m−2, P < 0.001) than patients without acute kidney injury. Multivariable regression analysis showed that advanced age (OR 1.03, P = 0.003), high body mass index (OR 1.10, P = 0.024), preoperative atrial arrhythmia (OR 3.12, P = 0.041), renal dysfunction (OR 2.70 P = 0.043), high central venous pressure (OR 1.12, P = 0.002), and low cardiac index (OR 0.36, P = 0.009) were associated with a high risk of postoperative acute kidney injury. A nomogram was established based on the regression results. The model showed good model fitness (Hosmer-Lemeshow test P = 0.881), with an area under the curve value of 0.78 (95% CI: 0.71, 0.84, P < 0.001). Conclusion The prediction model may help with early recognition, management, and reduction of acute kidney injury after pericardiectomy.
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Affiliation(s)
- Jin Wang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chunhua Yu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Chunhua Yu
| | - Yuelun Zhang
- Department of Biostatistics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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15
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Benjamin SR, Mohammad A, Shankar R, Kuruvilla KT, Philip MA, Thankachen R, Gnanamuthu BR, Kesavan P. Does tuberculosis affect surgical outcomes following pericardiectomy for chronic constrictive pericarditis? Twelve years’ experience from a tertiary care center in India. Indian J Thorac Cardiovasc Surg 2022; 38:241-250. [PMID: 35529004 PMCID: PMC9023633 DOI: 10.1007/s12055-021-01313-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 12/04/2021] [Accepted: 12/07/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction and purpose Tuberculosis (TB) is the commonest cause of chronic constrictive pericarditis (CCP) in India, unlike in the western countries. Pericardiectomy is the treatment of choice for CCP. Surgery in TB CCP is considerably more difficult than it is for other etiologies. The role of TB as an independent predictor for adverse surgical outcomes had not been properly evaluated in the Indian scenario. Hence, the aim of this study was to retrospectively analyze our results of surgery for CCP and the pre-operative factors that influenced post-operative outcomes. Methods The data of all adult patients who underwent pericardiectomy for CCP, between the years 2009 and 2020, maintained in a live database in our institute, were retrieved and analyzed. Results There were 124 patients in the study. The average age was 32 years. The male to female ratio was 3:1. TB was the commonest cause of CCP, identified in 64 (51.6%) patients. Complete anterior pericardiectomy (CAP) was possible in 122 (98.3%) patients. All the patients had significant drop in their central venous pressure (CVP) (10.25 ± 3.47 mmHg) after surgery. The operative time (p = 0.008), intra-operative blood loss (p = 0.02), intensive care unit (ICU) stay (p = 0.03), and hospital stay (p = 0.028) were significantly higher in the TB group. Apart from TB, the other pre-operative variables that predicted adverse outcomes were male sex, presence of pleural effusion or ascites, and advanced New York Heart Association (NYHA) class. There were 7 (5.6%) post-operative complications and 3 (2.4%) in-hospital deaths. Conclusion The high incidence of TB CCP makes a pericardiectomy in developing countries technically more challenging resulting in increased operative time, more blood loss, and prolonged ICU and hospital stay, but did not affect in-hospital mortality or morbidity.
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Affiliation(s)
- Santhosh Regini Benjamin
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
| | - Aamir Mohammad
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
| | - Ravi Shankar
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
| | - Korah Thomas Kuruvilla
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
| | - Madhu Andrew Philip
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
| | - Roy Thankachen
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
| | - Birla Roy Gnanamuthu
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
| | - Premprasath Kesavan
- The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India
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Pahwa S. Pericardiectomy for constrictive pericarditis after mediastinal irradiation-Need for functional assessment. J Card Surg 2022; 37:706. [PMID: 34997779 DOI: 10.1111/jocs.16218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Siddharth Pahwa
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky, USA
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17
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Lak HM, Anthony CM, Furqan MM, Verma BR, Gad M, Chawla S, Yasmin F, Kwon DH, Johnston DR, Klein AL. Refractory Recurrent Pericarditis After Pericardiectomy in a Young Woman. JACC Case Rep 2021; 3:1877-1882. [PMID: 34917971 PMCID: PMC8642733 DOI: 10.1016/j.jaccas.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/21/2021] [Accepted: 10/13/2021] [Indexed: 11/10/2022]
Abstract
Pericardiectomy is the recommended treatment for patients with recurrent pericarditis and refractory symptoms despite optimal anti-inflammatory therapy. We present a case of a 40-year-old woman who underwent total pericardiectomy after multiple episodes of pericarditis that was refractory to optimal guideline-derived medical therapy, including anti-inflammatory and biologic agents, who continued to have relapsing symptoms even after pericardiectomy. (Level of Difficulty: Intermediate.)
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Affiliation(s)
| | - Chris M Anthony
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Muhammad M Furqan
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Beni Rai Verma
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Gad
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sanchit Chawla
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Deborah H Kwon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Douglas R Johnston
- Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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18
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Pahwa S, Crestanello J, Miranda W, Bernabei A, Polycarpou A, Schaff H, Dearani J, Stulak J, Pochettino A, Daly R, Lahr B, Viehman J, Greason K. Outcomes of pericardiectomy for constrictive pericarditis following mediastinal irradiation. J Card Surg 2021; 36:4636-4642. [PMID: 34547827 DOI: 10.1111/jocs.15996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pericardiectomy for postradiation constrictive pericarditis has been reported to generally have unfavorable outcomes. This study sought to evaluate surgical outcomes in a large cohort of patients undergoing pericardiectomy for radiation-associated pericardial constriction. METHODS A retrospective analysis of all patients (≥18 years) who underwent pericardiectomy for a diagnosis of constrictive pericarditis with a prior history of mediastinal irradiation from June 2002 to June 2019 was conducted. There were 100 patients (mean age 57.2 ± 10.1 years, 49% females) who met the inclusion criteria. Records were reviewed to look at the surgical approach, the extent of resection, early mortality, and late survival. RESULTS The overall operative mortality was 10.1% (n = 10). The rate of operative mortality decreased over the study period; however, the test of the trend was not statistically significant (p = .062). Hodgkin's disease was the most common malignancy (64%) for which mediastinal radiation had been received. Only 27% of patients had an isolated pericardiectomy, and concomitant pericardiectomy and valve surgery were performed in 46% of patients. Radical resection was performed in 50% of patients, whereas 47% of patients underwent subtotal resection. Prolonged ventilation (26%), atrial fibrillation (21%), and pleural effusion (16%) were the most common postoperative complications. The overall 1, 5-, and 10-years survival was 73.6%, 53.4%, and 32.1%, respectively. Increasing age (hazard ratio, 1.044, 95% confidence interval 1.017-1.073) appeared to have a significant negative effect on overall survival in the univariate model. CONCLUSION Pericardiectomy performed for radiation-associated constrictive pericarditis has poor long-term outcomes. The early mortality, though high (~10%), has been showing a decreasing trend in the test of time.
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Affiliation(s)
- Siddharth Pahwa
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - William Miranda
- Department of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Annalisa Bernabei
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Andreas Polycarpou
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Hartzell Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alberto Pochettino
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian Lahr
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason Viehman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
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19
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Faiza Z, Prakash A, Namburi N, Johnson B, Timsina L, Lee LS. Fifteen-year experience with pericardiectomy at a tertiary referral center. J Cardiothorac Surg 2021; 16:180. [PMID: 34158104 PMCID: PMC8220762 DOI: 10.1186/s13019-021-01561-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/08/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Pericardiectomy has traditionally carried relatively high perioperative mortality and morbidity, with few published reports of intermediate- and long- term outcomes. We investigated our 15-year experience performing pericardiectomy at our institution. Methods Retrospective study of all patients who underwent pericardiectomy at our institution between 2005 and 2019. Baseline demographics, intraoperative details, and postoperative outcomes including long-term survival were analyzed. Results Sixty-three patients were included in the study. 66.7% of subjects underwent isolated pericardiectomy while 33.3% underwent pericardiectomy concomitantly with another cardiac surgical procedure. The most common indications for pericardiectomy were constrictive (79.4%) and hemorrhagic (9.5%) pericarditis. Preoperatively, 76.2% of patients were New York Heart Association class II and III, while postoperatively, 71.4% were class I and II. One-, three-, five-, and ten- year overall mortality was 9.5, 14.3, 20.6, and 25.4%, respectively. Overall pericarditis recurrence rate was 4.8%. Conclusion Pericardiectomy carries relatively high overall mortality rates, which likely reflects underlying disease etiology and comorbidities. Patients with prior cardiac intervention, history of dialysis, and immunocompromised state are associated with worse outcomes.
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Affiliation(s)
- Zainab Faiza
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1801 N. Senate Blvd., Suite 3300, Indianapolis, IN, 46202, USA
| | - Anjali Prakash
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1801 N. Senate Blvd., Suite 3300, Indianapolis, IN, 46202, USA
| | - Niharika Namburi
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1801 N. Senate Blvd., Suite 3300, Indianapolis, IN, 46202, USA
| | - Bailey Johnson
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1801 N. Senate Blvd., Suite 3300, Indianapolis, IN, 46202, USA
| | - Lava Timsina
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1801 N. Senate Blvd., Suite 3300, Indianapolis, IN, 46202, USA
| | - Lawrence S Lee
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1801 N. Senate Blvd., Suite 3300, Indianapolis, IN, 46202, USA.
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20
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Liu VC, Fritz AV, Burtoft MA, Martin AK, Greason KL, Ramakrishna H. Pericardiectomy for Constrictive Pericarditis: Analysis of Outcomes. J Cardiothorac Vasc Anesth 2021; 35:3797-3805. [PMID: 33722460 DOI: 10.1053/j.jvca.2021.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 01/17/2023]
Abstract
Constrictive pericarditis is caused by pericardial inflammation and fibrosis, leading to diastolic heart failure. The diagnosis requires a high index of suspicion because it often can mimic restrictive myocardial disease and cardiac tamponade and can be associated with severe tricuspid regurgitation and chronic liver disease. Patients who remain undiagnosed can experience a 90% mortality rate, and for those who undergo pericardiectomy, the survival rate varies significantly, depending on the underlying etiology and preoperative functional class of the patient. In this article, the authors review the pathophysiology, echocardiographic findings, management, and surgical outcomes of constrictive pericarditis to aid the cardiothoracic anesthesiologist in the perioperative management of this disorder.
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Affiliation(s)
- Victor C Liu
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Ashley V Fritz
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Melissa A Burtoft
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Archer K Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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21
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Moreyra AE, Cosgrove NM, Zinonos S, Yang Y, Cabrera J, Pepe RJ, Alam A, Kostis JB, Lee L, Kostis WJ. Constrictive Pericarditis after Open Heart Surgery: A 20-Year Case Controlled Study. Int J Cardiol 2021; 329:63-66. [PMID: 33421450 DOI: 10.1016/j.ijcard.2020.12.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/14/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Constrictive pericarditis is a rare complication of open heart surgery (OHS), but little is known regarding the etiologic determinants, and prognostic factors. The purpose of this study was to investigate clinical predictors and long term prognosis of post-operative constrictive pericarditis (CP). METHODS Using the Myocardial Infarction Data Acquisition System database, we analyzed records of 142,837 patients who were admitted for OHS in New Jersey hospitals between 1995 and 2015. Ninety-one patients were hospitalized with CP 30 days or longer after discharge from OHS. Differences in proportions were analyzed using Chi square tests. Controls were matched to cases for demographics, surgical procedure type, history of OHS, and propensity score. Cox proportional hazard models were used to evaluate the risk of all-cause death. Log-rank tests and Cox models were used to assess differences in the Kaplan-Meier survival curves with and without adjustments for comorbidities. RESULTS Patients with CP were more likely to have history of valve disease (VD, p < 0.001), atrial fibrillation (AF, p = 0.024) renal disease (CKD, p = 0.028), hemodialysis (HD, p = 0.008), previous OHS (p < 0.001). Patients with CP compared to matched controls had a higher 7-year mortality (p < 0.001). This difference became statistically significant at 1-year after surgery. CONCLUSION CP is a rare complication of OHS that occurs more frequently in patients with VD, AF, CKD, HD, multiple OHS, and it is associated with an unfavorable long-term prognosis. Given the large number of OHS performed every year, the results highlight the need for clinicians to recognize and properly manage this complication of OHS.
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Affiliation(s)
- Abel E Moreyra
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Nora M Cosgrove
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Stavros Zinonos
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Yi Yang
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Javier Cabrera
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Russell J Pepe
- Department of Surgery, Hofstra-Northwell, North Shore, NY, USA
| | - Amit Alam
- Baylor University Medical Center, Division of Cardiology, Department of Advanced Heart Failure, Dallas, TX, USA
| | - John B Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Leonard Lee
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - William J Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Abstract
Als Perikarditis wird eine Entzündung des Herzbeutels bezeichnet, die mit einem Perikarderguss oder einer entzündlichen Reaktion des Myokards (Perimyokarditis) einhergehen kann. Die Perikarditis kann im Rahmen von entzündlich rheumatischen Systemerkrankungen oder als eigenständige Erkrankung vorkommen. Rezidivierende Perikarditisepisoden ohne fassbare Ursache werden als idiopathische rekurrierende Perikarditis (IRP) bezeichnet, welche wesentliche Gemeinsamkeiten mit autoinflammatorischen Erkrankungen aufweist. Der Artikel gibt einen Überblick über die Häufigkeit des Auftretens einer Perikarditis bei rheumatologischen Erkrankungen. Weiterhin werden Klinik und Pathophysiologie der IRP diskutiert. Abschließend wird die Therapie der akuten und idiopathischen Perikarditis erläutert.
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Calderon-Rojas R, Greason KL, King KS, Oh JK, Stulak JM, Daly RC, Dearani JA, Schaff HV. Tricuspid Valve Regurgitation in Patients Undergoing Pericardiectomy for Constrictive Pericarditis. Semin Thorac Cardiovasc Surg 2020; 32:721-728. [DOI: 10.1053/j.semtcvs.2020.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 11/11/2022]
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Chiabrando JG, Bonaventura A, Vecchié A, Wohlford GF, Mauro AG, Jordan JH, Grizzard JD, Montecucco F, Berrocal DH, Brucato A, Imazio M, Abbate A. Management of Acute and Recurrent Pericarditis. J Am Coll Cardiol 2020; 75:76-92. [DOI: 10.1016/j.jacc.2019.11.021] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022]
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25
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Ala CK, Klein AL, Moslehi JJ. Cancer Treatment-Associated Pericardial Disease: Epidemiology, Clinical Presentation, Diagnosis, and Management. Curr Cardiol Rep 2019; 21:156. [PMID: 31768769 DOI: 10.1007/s11886-019-1225-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Cancer therapeutics have seen tremendous growth in the last decade and have been effective in the treatment of several cancer types. However, with advanced therapies like kinase inhibitors and immunotherapies, there have been unintended consequences of cardiotoxicities. While traditional chemotherapy and radiation-induced cardiotoxicity have been well studied, further research is needed to understand the adverse effects of newer regimens. RECENT FINDINGS Both immune-mediated and non-immune-medicated cytotoxicity have been noted with targeted therapies such as tyrosine kinase inhibitors and immune checkpoint inhibitors. In this manuscript, we describe the pericardial syndromes associated with cancer therapies and propose management strategies. Pericardial effusion and pericarditis are common presentations in cancer patients and often difficult to diagnose. Concomitant myocarditis may also present with pericardial toxicity, especially with immunotherapies. In addition to proper history and physical, additional testing such as cardiovascular imaging and tissue histology need to be obtained as appropriate. Holding the offending oncology drug, and institution of anti-inflammatory medications, and immunosuppressants such as steroids are indicated. A high index of suspicion, use of standardized definitions, and comprehensive evaluation are needed for early identification, appropriate treatment, and better outcomes for patients with cancer treatment-associated pericardial disease. Further research is needed to understand the pathophysiology and to evaluate how the management of pericardial conditions in these patients differ from traditional management and also evaluate new therapies.
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Affiliation(s)
- Chandra K Ala
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Cardiology, Detroit Medical Center/Wayne State University, Detroit, MI, USA
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Javid J Moslehi
- Division of Cardiovascular Medicine, Cardio-Oncology Program, Vanderbilt University Medical Center, Nashville, TN, USA.
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Mori M, Mullan CW, Bin Mahmood SU, Yousef S, Pelletier KJ, Mangi AA, Geirsson A. US National Trends in the Management and Outcomes of Constrictive Pericarditis: 2005-2014. Can J Cardiol 2019; 35:1394-1399. [DOI: 10.1016/j.cjca.2019.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/15/2019] [Accepted: 05/14/2019] [Indexed: 02/01/2023] Open
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Vogt JC, Nishimura RA, Newman DB. Middle-aged Man With Exertional Dyspnea and Neck Fullness. JAMA Cardiol 2019; 4:1045-1046. [DOI: 10.1001/jamacardio.2019.1677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Joshua C. Vogt
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rick A. Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - D. Brian Newman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Yunfei L, Tao L, Yongjun Q. Re-pericardiectomy for recurrent chronic constrictive pericarditis: left anterolateral thoracotomy is a better approach. J Cardiothorac Surg 2019; 14:152. [PMID: 31439013 PMCID: PMC6704570 DOI: 10.1186/s13019-019-0978-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 08/15/2019] [Indexed: 02/05/2023] Open
Abstract
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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Affiliation(s)
- Ling Yunfei
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guoxuexiang 37th, 610041, Chengdu, Sichuan, People's Republic of China
| | - Li Tao
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guoxuexiang 37th, 610041, Chengdu, Sichuan, People's Republic of China
| | - Qian Yongjun
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guoxuexiang 37th, 610041, Chengdu, Sichuan, People's Republic of China.
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Bowdish ME, Elsayed RS, Starnes VA. Invited Commentary. Ann Thorac Surg 2019; 108:1381-1382. [PMID: 31255611 DOI: 10.1016/j.athoracsur.2019.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Michael E Bowdish
- Departments of Surgery and Preventive Medicine, Keck School of Medicine of USC, 1520 San Pablo St, HC2 Ste 4300, Los Angeles, CA 90033.
| | - Ramsey S Elsayed
- Department of Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Vaughn A Starnes
- Department of Surgery, Keck School of Medicine of USC, Los Angeles, California
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30
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Gatti G, Fiore A, Ternacle J, Porcari A, Fiorica I, Poletti A, Ecarnot F, Bussani R, Pappalardo A, Chocron S, Folliguet T, Perrotti A. Pericardiectomy for constrictive pericarditis: a risk factor analysis for early and late failure. Heart Vessels 2019; 35:92-103. [DOI: 10.1007/s00380-019-01464-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/21/2019] [Indexed: 12/13/2022]
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32
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33
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Tuck BC, Townsley MM. Clinical Update in Pericardial Diseases. J Cardiothorac Vasc Anesth 2019; 33:184-199. [DOI: 10.1053/j.jvca.2018.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Indexed: 01/15/2023]
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Abstract
Effusive-constrictive pericarditis (ECP) corresponds to the coexistence of a hemodynamically significant pericardial effusion and decreased pericardial compliance. The hallmark of ECP is the persistence of elevated right atrial pressure postpericardiocentesis. The prevalence of ECP seems higher in tuberculous pericarditis and lower in idiopathic cases. The diagnosis of ECP is traditionally based on invasive hemodynamics but the presence of echocardiographic features of constrictive pericarditis post-pericardiocentesisis can also identify ECP. Data on the prognosis and optimal treatment of ECP are still limited. Anti-inflammatory agents should be the first line of treatment. Pericardiectomy should be reserved for refractory cases.
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Affiliation(s)
- William R Miranda
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Jae K Oh
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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Reply. Ann Thorac Surg 2018; 105:1280-1281. [PMID: 29571334 DOI: 10.1016/j.athoracsur.2017.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 10/21/2017] [Indexed: 11/22/2022]
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Effectiveness and long-term outcomes of surgical intervention for constrictive epicardium in constrictive pericarditis. Gen Thorac Cardiovasc Surg 2017; 66:137-144. [PMID: 29080093 DOI: 10.1007/s11748-017-0854-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/23/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Epicardial resection is considered effective in patients with constrictive pericarditis accompanied by epicardial constriction, but few publications have evaluated its long-term outcomes. The study objective was to evaluate early and late results of epicardial resection. METHODS A total of 22 patients with pericardiectomy for constrictive pericarditis were treated at our institution between 1989 and 2016. They were stratified by the presence or absence of constrictive epicardium and the surgical intervention performed. Group A (n = 7) included those with constrictive epicardium and epicardial resection in addition to pericardiectomy. Group B (n = 5) included those with constrictive epicardium and single pericardiectomy. Group C (n = 10) included those without constrictive epicardium and with a single pericardiectomy. Postsurgical changes were evaluated by echocardiography. RESULTS No significant differences were found in preoperative baseline characteristics, operative details, and operative mortality among the groups. The median postoperative follow-up was 80 months. Group A patients did not experience cardiac events, and left ventricular end-diastolic volume and stroke volume were significantly improved at late follow-up compared with before and soon after surgery. The early postsurgical parameters were significantly improved in Group C patients, but the improvements were attenuated on late follow-up. Group B patients had the highest occurrence of cardiac events and no improvement in echocardiographic parameters. CONCLUSION Surgical intervention in constrictive epicardium improved echocardiographic parameters and was free of cardiac events during long-term follow-up.
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Murashita T, Schaff HV, Daly RC, Oh JK, Dearani JA, Stulak JM, King KS, Greason KL. Experience With Pericardiectomy for Constrictive Pericarditis Over Eight Decades. Ann Thorac Surg 2017; 104:742-750. [PMID: 28760468 DOI: 10.1016/j.athoracsur.2017.05.063] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/05/2017] [Accepted: 05/19/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND The purpose of this study was to review the surgical outcomes of pericardiectomy for constrictive pericarditis and to examine risk factors for overall mortality in a contemporary period. METHODS We reviewed all patients who underwent pericardiectomy for constriction from 1936 through 2013. The investigation included constrictive pericarditis cases confirmed intraoperatively, all other types of pericarditis were excluded; 1,071 pericardiectomies were performed in 1,066 individual patients. Patients were divided into two intervals: a historical (pre-1990) group (n = 259) and a contemporary (1990-2013) group (n = 807). RESULTS Patients in the contemporary group were older (61 versus 49 years; p < 0.001), more symptomatic (NYHA class III or IV in 79.6% versus 71.2%; p < 0.001), and more frequently underwent concomitant procedures (21.4% versus 5.4%; p < 0.001) compared with those in the historical group. In contrast to the historical cases in which the etiologies of constriction were mostly idiopathic (81.1%), nearly half of contemporary cases had a nonidiopathic etiology (postoperative 32.3%, radiation 11.4%). Although 30-day mortality decreased from 13.5% in the historical era to 5.2% in the contemporary era (p < 0.001), overall survival was similar after adjusting for patient characteristics. Risk factors of overall mortality in the contemporary group included NYHA class III or IV (HR 2.17, p < 0.001), etiology of radiation (HR 3.93, p < 0.001) or postcardiac surgery (HR 1.47, p < 0.001), and need for cardiopulmonary bypass (HR 1.35, p = 0.014). CONCLUSIONS There was a significant change in disease etiology over the study period. Long-term survival after pericardiectomy is affected by patient characteristics including etiology of constriction and severity of symptoms.
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Affiliation(s)
- Takashi Murashita
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jae K Oh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Katherine S King
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
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Abstract
Disease of the pericardium represents a relatively rare indication for cardiac surgery, and there exist no widely accepted guidelines for surgical management. As such, the surgical approach to the pericardium has relied largely on institutional experience with a slow evolution based on published studies. In particular, management of pericardial constriction has varied widely from surgeon to surgeon and institution to institution, in large part due to a perception of inherent high risk to the procedure. This review covers the current practice of surgery for disease of the pericardium, with particular focus on the evolution of indications for pericardiectomy, new applications in inflammatory or relapsing pericarditis, and the progressive refinement in surgical technique and operative planning which have led to significantly improved outcomes in experienced centers.
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Constrictive Pericarditis: A Practical Clinical Approach. Prog Cardiovasc Dis 2017; 59:369-379. [DOI: 10.1016/j.pcad.2016.12.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 12/29/2016] [Indexed: 02/06/2023]
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40
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Conti VR. Constriction, effusion, or both: Radical pericardiectomy with improved outcomes. J Thorac Cardiovasc Surg 2016; 152:459-60. [PMID: 27179840 DOI: 10.1016/j.jtcvs.2016.03.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 03/30/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Vincent R Conti
- Department of Surgery, University of Texas Medical Branch at Galveston, Galveston, Tex.
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