Our Summary

The research paper is about a study conducted on a group of patients who underwent a surgical procedure called pericardiectomy to treat a heart condition known as constrictive pericarditis. This condition involves a hardening and thickening of the pericardium, the sac that encloses the heart, causing it to constrict and thus affect heart function. Surgery is the only treatment available for this condition, but there have been concerns about high death rates after surgery.

The study took place between 2005 and 2017, and it involved 55 patients. The researchers documented everything about the patients’ condition, the surgery, and what happened to the patients afterwards.

The cause of the condition was unknown in most of the cases. About 60% of the patients were in a severe stage of the condition. During the surgery, some patients had other procedures done at the same time. The surgeons were able to fully remove the hardened pericardium in 96% of the cases. One patient died during hospitalization, and four had to have further surgery due to bleeding.

During the follow-up period, which on average lasted about 4 years, 12 patients died, but only one of these deaths was due to failure of the right side of the heart. The condition of the patients significantly improved after the surgery, they were able to stop taking diuretic medications, and the pressure in the right atrium of the heart was significantly reduced.

The study concludes that the surgery is safe and effective for treating constrictive pericarditis, regardless of whether other procedures are done at the same time.

FAQs

  1. What is the most common cause of constrictive pericarditis?
  2. What is the efficacy of surgical pericardiectomy for the treatment of constrictive pericarditis?
  3. Are there significant differences in outcomes when other interventions are performed simultaneously with surgical pericardiectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pericardiectomy is to follow post-operative care instructions carefully, including taking medications as prescribed, attending follow-up appointments, and gradually increasing physical activity as directed by your healthcare provider. It is important to communicate any concerning symptoms or changes in your condition to your healthcare team promptly.

Suitable For

Patients with constrictive pericarditis who are in functional class 3/4, have symptoms of right heart failure, and have failed medical management are typically recommended for pericardiectomy. Patients with idiopathic or other known etiologies of constrictive pericarditis may also be candidates for pericardiectomy. Patients with severe symptoms, such as shortness of breath, fatigue, and edema, may benefit from surgical intervention to improve their quality of life and reduce the risk of complications associated with constrictive pericarditis.

Timeline

  • Before pericardiectomy:
  1. Patient presents with symptoms of constrictive pericarditis, such as shortness of breath, fatigue, and edema.
  2. Comprehensive testing is done including echocardiography, computed tomography, and hemodynamic studies to confirm the diagnosis.
  3. Surgery is recommended as the therapeutic option for the patient.
  4. Patient undergoes surgical pericardiectomy, which may involve concomitant interventions and the use of cardiopulmonary bypass.
  5. Complete resection of the pericardium is achieved in 96% of cases.
  6. One patient dies during the index hospitalization, and a few patients require re-explorations due to bleeding.
  • After pericardiectomy:
  1. Patient’s functional class significantly improves, with the discontinuation of diuretics in all cases.
  2. Significant reductions in right atrial pressures are recorded post-surgery.
  3. Mortality rate during a mean follow-up of 52 ± 39 months is low, with only 1 death due to right heart failure.
  4. Overall, short- and long-term outcomes of surgical pericardiectomy indicate high safety and favorable clinical and hemodynamic efficacy for the treatment of constrictive pericarditis.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with pericardiectomy?
  2. How long is the recovery period after pericardiectomy surgery?
  3. How likely is it that the symptoms of constrictive pericarditis will improve after pericardiectomy?
  4. Will I need to take medication or undergo any other treatments after the surgery?
  5. How often will I need follow-up appointments after pericardiectomy?
  6. Are there any specific lifestyle changes I should make after pericardiectomy?
  7. What is the success rate of pericardiectomy in improving symptoms and overall quality of life?
  8. Are there any specific factors that may affect the outcome of pericardiectomy in my case?
  9. How experienced is the surgical team in performing pericardiectomy procedures?
  10. Are there any alternative treatment options for constrictive pericarditis that I should consider before deciding on pericardiectomy?

Reference

Authors: Nachum E, Sternik L, Kassif Y, Raanani E, Hay I, Shalabi A, Buber J. Journal: Thorac Cardiovasc Surg. 2020 Dec;68(8):730-736. doi: 10.1055/s-0038-1645869. Epub 2018 May 27. PMID: 29804284