Pericardiectomy for chronic constrictive pericarditis: risks factors and predictors of survival

• Published in: Indian journal of thoracic and cardiovascular surgery 2014-09, Vol.30 (3), p.196-202
• Main Authors: Mahapatra, Rudra Pratap, Kumar, Ravinutala Venkata, Tella, Ramakrishna Dev, Barik, Ramachandra, Krishna, Lanka, Malempati, Amaresh Rao
• Format: Article
• Language: English
• Subjects: Cardiac Surgery; Medicine; Medicine & Public Health; Original Article; Surgery; Thoracic Surgery; Vascular Surgery
• ISSN: 0970-9134; 0973-7723
• DOI: 10.1007/s12055-014-0308-7

Objective We have performed this study to (1) evaluate the major etiological factors of chronic constrictive pericarditis in this geographical region, (2) evaluate the effect of preoperative optimization, (3) find the best surgical approach, (4) assess the extent of decortication required, (5) evaluate the management of immediate postoperative low cardiac output and (6) determine the predictors of early and long-term survival. Materials and methods A retrospective analysis was undertaken in 32 consecutive patients of which 26 were male and 6 female with a mean age of 34.86 years (range 6–64 years), who underwent pericardiectomy for chronic constrictive pericarditis over a period of 5 years (2009–2013), in the affiliated institute in south India. Results The perioperative mortality rate was 9.3 %. Tuberculosis was the most common etiology, accounting for 22 cases (68.75 %). Median sternotomy was the most preferred surgical approach, done in 30 patients (93.70 %). Total pericardiectomy was the most preferred surgical procedure, done in 29 patients (90.62 %). Advanced age, atrial fibrillation, concomitant mitral or tricuspid insufficiency, coronary involvement, and low cardiac output state were significant negative predictors of survival. Improved functional status was noted in 24 of the 26 surviving patients (92.30 %) and improvement of NYHA status was observed in 25 of the 26 surviving patients (96.15 %). The actuarial survival in all at 5 years was 84.3 %. Conclusion Tuberculosis is the most common etiology for constrictive pericarditis. Median sternotomy is the preferable surgical approach. Total pericardiectomy provides lower perioperative mortality, independent of etiology. Pericardiectomy should be performed early after proper preoperative optimization. Immediate postoperative low cardiac output states should be managed carefully.