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Huang JB, Lu CC, Wen ZK. Pericardiectomy with routine cardiopulmonary bypass: a multicenter, randomized controlled trial. Trials 2025; 26:138. [PMID: 40269976 PMCID: PMC12020316 DOI: 10.1186/s13063-025-08843-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Accepted: 04/15/2025] [Indexed: 04/25/2025] Open
Abstract
Constrictive pericarditis is a result of chronic inflammation characterized by thickening and calcification of pericardial fibers, impaired diastolic filling, reduced cardiac output, and ultimately heart failure. The main objective of this multicenter trial is to evaluate whether conventional extracorporeal circulation pericardial resection has a better prognosis than pericardial resection without extracorporeal circulation. This study is a multicenter, randomized controlled, evaluator blinded, parallel group study with an advantageous framework. A total of 436 participants with constrictive pericarditis will be randomly assigned to either the extracorporeal circulation pericardial resection group or the non-extracorporeal circulation pericardial clearance group in a 1:1 ratio using a computer. Incomplete pericardial detachment is associated with low cardiac output syndrome after pericardial resection. The causes of low cardiac output syndrome are related to incomplete resection of thickened pericardium, unsatisfactory relief of left ventricular compression, excessive ventricular dilation after pericardial dissection, myocardial weakness, and heart failure. The relief of left ventricular compression is crucial for the postoperative recovery of cardiac function.
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Affiliation(s)
- Jing-Bin Huang
- Department of Cardiothoracic Surgery, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan Road, Nanning, Guangxi, 530021, China.
| | - Chang-Chao Lu
- Department of Cardiothoracic Surgery, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan Road, Nanning, Guangxi, 530021, China
| | - Zhao-Ke Wen
- Department of Cardiothoracic Surgery, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan Road, Nanning, Guangxi, 530021, China
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Jia B, Yan S, Luo Y, Cheng J, Cheng J, Fei J, Gao Y, Liao X, Bian L, Wang J, Teng Y, Liu G, Gao L, Ji B. Post-pericardiectomy ECMO for constrictive pericarditis: a case series and literature review. BMC Anesthesiol 2025; 25:110. [PMID: 40025418 PMCID: PMC11871819 DOI: 10.1186/s12871-025-02977-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2024] [Accepted: 02/17/2025] [Indexed: 03/04/2025] Open
Abstract
BACKGROUND Pericardiectomy is the curative treatment for constrictive pericarditis, yet postoperative low cardiac output syndrome (LCOS) may occur. The application of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in post-pericardiectomy refractory LCOS has limited case reports, and its effectiveness and safety remain unclear. This study aims to provide evidence for the effectiveness of ECMO in treating post-pericardiectomy refractory LCOS. METHODS Nine cases of post-pericardiectomy ECMO from two high-volume pericardiectomy centers in China were retrospectively reviewed. Meanwhile, a literature search was performed in PubMed and Embase on December 4, 2024. After screening, 5 articles were finally included for data extraction and comprehensive analysis. RESULTS Case Series: There were 4 cases of tuberculous etiology, 1 with a history of cardiac surgery, and 4 idiopathic cases. All patients were in New York Heart Association class III - IV at baseline. All the patients undertwent pericardiectomy via median sternotomy, and 5 patients underwent concomitant valve procedures. One patient failed to wean from the cardiopulmonary bypass (CPB) and was transferred to femoral VA-ECMO. Eight patients received femoral VA-ECMO support 4-96 h after surgery due to refractory LCOS. All the patients survived to discharge with good neurological outcomes after 120-192 h of ECMO support. Two patient were lost to follow-up, and the rest 7 patients survived to follow-up with a mean follow-up of 56 months. LITERATURE REVIEW 4 case reports and 1 retrospective study were identified. In the retrospective study of 69 patients, 8 received ECMO during or after pericardiectomy with a hospital mortality rate of 63%. The four Patients of the 4 case reports were all survival at hospital discharge. CONCLUSIONS VA-ECMO might be effective for refractory LCOS after pericardiectomy in patients with constrictive pericarditis, and could improve survival rates.
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Affiliation(s)
- Bin Jia
- Department of Cardiovascular Surgery, The third People's Hospital of Chengdu, Chengdu, Sichuan, Chaina, China
| | - Shujie Yan
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Disease, Beijing, China
| | - Yong Luo
- Department of Cardiovascular Surgery, The third People's Hospital of Chengdu, Chengdu, Sichuan, Chaina, China
| | - Jian Cheng
- Department of Cardiovascular Surgery, The third People's Hospital of Chengdu, Chengdu, Sichuan, Chaina, China
| | - Jie Cheng
- Department of Cardiovascular Surgery, The third People's Hospital of Chengdu, Chengdu, Sichuan, Chaina, China
| | - Junjie Fei
- Department of Cardiovascular Surgery, The third People's Hospital of Chengdu, Chengdu, Sichuan, Chaina, China
| | - Yushuang Gao
- Department of Cardiovascular Surgery, The third People's Hospital of Chengdu, Chengdu, Sichuan, Chaina, China
| | - Xiao Liao
- Department of Cardiovascular Surgery, The third People's Hospital of Chengdu, Chengdu, Sichuan, Chaina, China
| | - Luyu Bian
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Disease, Beijing, China
| | - Jian Wang
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Disease, Beijing, China
| | - Yuan Teng
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Disease, Beijing, China
| | - Gang Liu
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Disease, Beijing, China
| | - Lanying Gao
- Department of Cardiovascular Surgery, The third People's Hospital of Chengdu, Chengdu, Sichuan, Chaina, China.
| | - Bingyang Ji
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Disease, Beijing, China.
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Nugraha YK, Maimunah U. Perioperative management of constrictive pericarditis with cardiac cirrhosis: A case report. Int J Surg Case Rep 2024; 120:109843. [PMID: 38848659 PMCID: PMC11192800 DOI: 10.1016/j.ijscr.2024.109843] [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: 04/15/2024] [Revised: 05/26/2024] [Accepted: 05/30/2024] [Indexed: 06/09/2024] Open
Abstract
INTRODUCTION The interactions between the heart and liver have been known for a long time, pericarditis constrictive could cause congestive hepatopathy via right-sided heart failure. Liver cirrhosis correlates with a high risk of mortality so perioperative management greatly influences outcomes. CASE PRESENTATION An Indonesian man, 50 years old, complained of breath shortness. The patient had a history of pulmonary tuberculosis and was declared cured 30 years ago. The patient began experiencing fatigue 14 years ago, and the patient was diagnosed with constrictive pericarditis 5 years ago. Currently, the patient has an increased jugular venous pressure of 9 cmH2O and abnormal laboratory indicators, including a platelet count of 121,000/μL, albumin count of 3.41 g/L, direct bilirubin count of 0.7 mg/dL, total bilirubin count of 1.4 mg/dL, and INR of 1.4. Echocardiography revealed left ventricle hypertrophy, diastolic dysfunction, and right ventricle failure. Cardiac CT scan showed pericardial calcification. Abdominal ultrasound showed liver congestive and splenomegaly. Transient elastography showed severe fibrosis in liver and stiffness in spleen. The patient underwent pericardiectomy with CTP score of 6 and MELD of 12. The surgery was successful, and the complaint was reduced. The patient experienced an improvement in his condition and able to carry out activities well after 2 years post-surgery. DISCUSSION The patient has no contraindications to pericardiectomy, CTP class A (5-6) and MELD score <13.5 has a low risk of mortality. CONCLUSION CTP and MELD scores predict life expectancy in post-surgery cardiac cirrhosis patients.
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Affiliation(s)
- Yudha Klahan Nugraha
- Study Program of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Ummi Maimunah
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
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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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Fang L, Zhong F, Yu W, Zhu P, Yu G. The Important Role of Preoperative D-Dimer in Constrictive Pericarditis. Ther Clin Risk Manag 2024; 20:239-247. [PMID: 38736988 PMCID: PMC11087889 DOI: 10.2147/tcrm.s462075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/28/2024] [Indexed: 05/14/2024] Open
Abstract
Background The impact of coagulation indicators on postoperative outcomes of patients with constrictive pericarditis undergoing pericardiectomy has been poorly investigated. This study aimed to assess the prognostic role of preoperative coagulation indicators in these patients. Methods We retrospectively included 158 patients with constrictive pericarditis undergoing pericardiectomy. The diagnostic values of coagulation indicators for postoperative complications were evaluated by ROC curves. Patients were divided into two groups according to the cutoff value calculated by ROC curve. Postoperative outcomes were compared between the two groups. Logistic regression analysis was performed to identify risk factors of postoperative complications. Results ROC curve showed that among different coagulation indicators, preoperative D-dimer (DD) level could effectively identify patients with postoperative complications (AUC 0.771, 95% CI 0.696-0.847, P < 0.001). Patients were divided into the low DD group and the high DD group. The comparison of postoperative outcomes suggested that high preoperative DD level was significantly associated with longer durations of vasoactive agents using (P = 0.018), intubation (P = 0.020), ICU stay (P = 0.008), chest drainage (P=0.004) and hospital stay (P = 0.002). Multivariable analysis showed that high preoperative DD level was the independent risk factor of postoperative complications (OR 6.892, 95% CI 2.604-18.235, P < 0.001). Conclusion High preoperative DD level was significantly linked to poor postoperative outcomes and could provide an effective prediction ability for postoperative complications in patients with constrictive pericarditis.
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Affiliation(s)
- Likui Fang
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, 310003, People’s Republic of China
| | - Fangming Zhong
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, 310003, People’s Republic of China
| | - Wenfeng Yu
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, 310003, People’s Republic of China
| | - Pengfei Zhu
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, 310003, People’s Republic of China
| | - Guocan Yu
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, 310003, People’s Republic of China
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Saunders R, Garnett S, Lucchetti B, Jesty S. Case report: Treatment of constrictive epicarditis using the waffle procedure in a dog that had previously undergone a subtotal pericardiectomy. Front Vet Sci 2024; 11:1335433. [PMID: 38681847 PMCID: PMC11045964 DOI: 10.3389/fvets.2024.1335433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/04/2024] [Indexed: 05/01/2024] Open
Abstract
A 10 year-old female spayed German Short-haired Pointer dog weighing 26.8 kg (59 lb) presented with a 2 week history of recurrent ascites. The dog had a 4 year history of idiopathic pericardial effusion causing sporadic episodes of cardiac tamponade and secondary ascites. A subtotal pericardiectomy was performed 3 months prior to presentation. The patient had done well for 2 months following this procedure, at which point the large-volume modified transudate ascites recurred, necessitating abdominocentesis every 10 days. Thoracic and abdominal computed tomography (CT) revealed no abdominal or vascular cause of ascites. Transthoracic echocardiography performed under general anesthesia showed constrictive epicarditis (visceral pericarditis) resulting in diastolic dysfunction and right-sided congestive heart failure. A sternotomy was performed for a pericardial waffle procedure or crosshatch pericardiotomy-scoring of crosshatched incisions into the thickened epicardium. Echocardiographic findings postoperatively were consistent with resolved constrictive epicarditis. At 8 months postoperatively, the dog was clinically normal and had only required one abdominocentesis one month after the waffle procedure. This case report describes the successful treatment of a dog with constrictive epicarditis using a novel surgical technique (waffle procedure) that has not yet been described in veterinary medicine.
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Affiliation(s)
- Rebecca Saunders
- Charleston Veterinary Referral Center, Charleston, SC, United States
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Yeşiltaş MA, Kavala AA, Turkyilmaz S, Kuserli Y, Türkyilmaz G, Toz H, Özen C. Surgical treatment of constrictive pericarditis at a single center: 10 years of experience. Acta Chir Belg 2024; 124:107-113. [PMID: 37232347 DOI: 10.1080/00015458.2023.2216377] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Constrictive pericarditis (CP) is a pericardial disease characterized by the pericardium becoming calcified or fibrotic as a result of chronic inflammation, which impairs diastolic filling by compressing the cardiac chambers. Pericardiectomy is a promising surgical option for treating CP. In this study, we reviewed over 10 years of preoperative, perioperative, and short-term postoperative follow-ups of patients who underwent pericardiectomy for constrictive pericarditis at our clinic. METHODS Between January 2012 and May 2022, 44 patients were diagnosed with constrictive pericarditis. Twenty-six patients underwent pericardiectomy for CP. Median sternotomy is the surgical approach of choice because it provides easy access for complete pericardiectomy. RESULTS The patient median age was 56 (min: 32, max: 71), and 22 out of 26 patients (84.6%) were male. Twenty-one patients (80.8%) complained of dyspnea, which was the most common reason for admission. Twenty-four patients (92.3%) were scheduled for elective surgery. Cardiopulmonary bypass (CPB) was used during the procedure in six patients (23%). The duration of intensive care stay was two days (min: 1, max: 11), and the total hospitalization was six days (min: 4, max: 21). No in-hospital mortality was observed. CONCLUSION The median sternotomy approach provides a critical advantage in terms of performing a complete pericardiectomy. Although CP is a chronic condition, early diagnosis and planning of pericardiectomy before irreversible deterioration of cardiac function leads to a notable reduction in mortality and morbidity.
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Affiliation(s)
- Mehmet Ali Yeşiltaş
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ali Aycan Kavala
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Saygin Turkyilmaz
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Kuserli
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Gülsüm Türkyilmaz
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Hasan Toz
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Can Özen
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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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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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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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: 1.3] [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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Sohal S, Mathai SV, Lipat K, Kaur A, Visveswaran G, Cohen M, Waxman S, Tiwari N, Vucic E. Multimodality Imaging of Constrictive Pericarditis: Pathophysiology and New Concepts. Curr Cardiol Rep 2022; 24:1439-1453. [PMID: 35917048 PMCID: PMC9344806 DOI: 10.1007/s11886-022-01758-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/15/2022]
Abstract
Purpose of Review The unique pathophysiological changes of constrictive pericarditis (CP) can now be identified with better imaging modalities, thereby helping in its early diagnosis. Through this review, we outline the pathophysiology of CP and its translation into symptomology and various imaging findings which then are used for both diagnosis and guiding treatment options for CP. Recent Findings Multimodality imaging has provided us with the capability to recognize early stages of the disease and identify patients with a potential for reversibility and can be treated with medical management. Additionally, peri-procedural planning and prediction of post-operative complications has been made possible with the use of advanced imaging techniques. Summary Advanced imaging has the potential to play a greater role in identification of patients with reversible disease process and provide peri-procedural risk stratification, thereby improving outcomes for patients with CP.
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Affiliation(s)
- Sumit Sohal
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA.
| | - Sheetal Vasundara Mathai
- Division of Cardiovascular Diseases, Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Kevin Lipat
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Arpanjeet Kaur
- Department of Medicine, Mount Sinai West, 1000 Tenth Avenue, New York, NY, 10019, USA
| | - Gautam Visveswaran
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Marc Cohen
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Sergio Waxman
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Nidhish Tiwari
- Division of Cardiovascular Diseases, Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Esad Vucic
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
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12
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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: 3] [Impact Index Per Article: 1.0] [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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13
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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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14
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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: 0.5] [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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15
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Dybowska M, Szturmowicz M, Opoka L, Rudziński P, Tomkowski W. Intrapericardial recombinant tissue plasminogen activator in purulent pericarditis- case series. BMC Cardiovasc Disord 2020; 20:392. [PMID: 32854624 PMCID: PMC7451238 DOI: 10.1186/s12872-020-01674-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/19/2020] [Indexed: 12/31/2022] Open
Abstract
Background Pericardial constriction is one of the complications of purulent pericarditis (PP). Most difficult to treat, which may develop both in early and in the late period of the disease, resulting in a very poor prognosis. Case presentation We present case series of 4 patients with purulent pericarditis, in whom direct intrapericardial administration of recombinant tissue plasminogen activator (r-tPA) was used. Management of PP requires a combined surgical and medical approach. The most important is complete drainage of the effusion by subxiphoid pericardiotomy connected with complementary use of broad-spectrum antibiotics. Despite the use of broad- spectrum antibiotics, in some patients a large volume of daily drainage is still present. Constrictive pericarditis as a complication of PP is observed in majority of patients. Intrapericardial administration of fibrinolytic agents, although not strongly recommended, can improve efficacy of antibiotic treatment especially in patients with loculation fluid and can prevent the development of constrictive pericarditis. r-tPA was applied at a dose of 20 mg dissolved in 100 ml of normal saline in a 100 ml syringe, administered by a large pericardial drain (Pezzer drain) installed into the pericardial cavity during pericardioscopy. The tube was closed and re-opened after 24 h. No serious complications, such as bleeding, allergy or hypotension, were noted. Conclusion We present case series of 4 patients with purulent pericarditis, in whom direct intrapericardial administration of recombinant tissue plasminogen activator (r-tPA), prevented the development of constrictive pericarditis, and increased efficacy of antibiotic treatment without any significant complications.
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Affiliation(s)
- Małgorzata Dybowska
- I Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, ul Plocka 26, 01-138, Warsaw, Poland.
| | - Monika Szturmowicz
- I Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, ul Plocka 26, 01-138, Warsaw, Poland
| | - Lucyna Opoka
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, Plocka 26, 01-138, Warsaw, Poland
| | - Piotr Rudziński
- Department of Thoracic Surgery, National Tuberculosis and Lung Diseases Research Institute, Plocka 26, 01-138, Warsaw, Poland
| | - Witold Tomkowski
- I Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, ul Plocka 26, 01-138, Warsaw, Poland
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