Our Summary

This research paper is about a study conducted on 39 patients who underwent a type of heart surgery called pericardiectomy for a condition known as constrictive pericarditis. This condition is a severe form of inflammation of the pericardium, the protective sac around the heart, which can cause chest pain and difficulty breathing.

The study looked at patients who had this surgery between 1995 and 2016. Some patients were excluded because they had other surgeries at the same time. Most of the patients were male (79.5%) and the average age was 56.6 years. The causes of their pericarditis varied, with the majority being idiopathic (meaning the cause is unknown), followed by infection, rheumatic disorders, previous heart surgery, tuberculosis, and previous radiation treatment to the chest.

In all surgeries, the procedure was performed through a midline sternotomy (an incision through the middle of the chest). Some patients (41%) had the surgery electively using a heart-lung machine (cardiopulmonary bypass), while the others (59%) had surgery without this machine.

The study found that if the heart-lung machine was used, the 30-day death rate after surgery was 50%, although this has decreased to 13.8% since 2007. However, if the surgery was performed without a heart-lung machine, no patients died. Patients who used the heart-lung machine also had longer stays in the intensive care unit and required mechanical ventilation for longer.

Overall, the study concluded that pericardiectomy without the use of a heart-lung machine is a safe procedure with good outcomes for critically ill patients with constrictive pericarditis.

FAQs

  1. What is the aim of the retrospective study on pericardiectomy?
  2. What were the results of the study concerning the use of cardiopulmonary bypass during pericardiectomy?
  3. What conclusions were drawn from the study regarding the safety and outcome of pericardiectomy as a treatment for constrictive pericarditis?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pericardiectomy is to discuss with their healthcare provider the option of having the surgery performed without the use of cardiopulmonary bypass. This approach may result in a lower risk of mortality and shorter recovery time compared to surgeries performed with ECC. It is important for patients to understand the potential benefits and risks associated with different surgical techniques in order to make an informed decision about their treatment.

Suitable For

Patients who are typically recommended for pericardiectomy are those suffering from isolated severe constrictive pericarditis. This includes patients with underlying etiologies such as idiopathic pericarditis, infection, rheumatic disorders, status post cardiac surgery, tuberculosis, and status post mediastinal irradiation. Pericardiectomy may be recommended for patients who have failed medical management and have symptoms such as shortness of breath, chest pain, and fluid retention. Patients who are deemed to be in critical condition and may benefit from surgical intervention to relieve the constriction of the pericardium may also be candidates for pericardiectomy.

Timeline

  • Before pericardiectomy: The patient may present with symptoms such as shortness of breath, chest pain, fatigue, and swelling in the legs. Diagnostic tests such as echocardiography, MRI, and CT scans may be performed to confirm the diagnosis of constrictive pericarditis. The patient may be admitted to the hospital for further evaluation and management.

  • Pericardiectomy procedure: The surgery is typically performed through a midline sternotomy. In some cases, cardiopulmonary bypass with the heart beating may be used, while in others, surgery is performed without extracorporeal circulation. The underlying etiologies of constrictive pericarditis may include idiopathic pericarditis, infection, rheumatic disorders, tuberculosis, or previous cardiac surgery.

  • After pericardiectomy: The patient may experience a significant improvement in symptoms, such as resolution of shortness of breath and chest pain. The 30-day mortality rate for patients who underwent pericardiectomy with cardiopulmonary bypass was 50%, but decreased to 13.8% since 2007. Patients who had surgery without extracorporeal circulation had a mortality rate of 0%. The duration of ICU stay and mechanical ventilation was longer for patients who underwent surgery with cardiopulmonary bypass compared to those without. Overall, pericardiectomy was found to be a safe procedure with excellent outcomes in critically ill patients.

What to Ask Your Doctor

  1. What is the underlying cause of my constrictive pericarditis?
  2. What are the risks and benefits of undergoing a pericardiectomy procedure?
  3. Will I need to be placed on cardiopulmonary bypass during the surgery?
  4. What is the expected recovery time following the surgery?
  5. Are there any potential complications or long-term effects associated with pericardiectomy?
  6. How will my symptoms improve after undergoing the procedure?
  7. Will I need any follow-up care or monitoring after the surgery?
  8. Are there any alternative treatment options available for my condition?
  9. How experienced is the surgical team in performing pericardiectomy procedures?
  10. What is the success rate for pericardiectomy in patients with constrictive pericarditis?

Reference

Authors: Rupprecht L, Putz C, Flörchinger B, Zausig Y, Camboni D, Unsöld B, Schmid C. Journal: Thorac Cardiovasc Surg. 2018 Nov;66(8):645-650. doi: 10.1055/s-0037-1604303. Epub 2017 Aug 6. PMID: 28780766