Our Summary

This research paper is about a study that was conducted over a 25 year period (from 1991 to 2016) on 41 patients who underwent surgery for a heart condition known as chronic constrictive pericarditis. This condition involves inflammation and hardening of the pericardium, the thin sac-like membrane surrounding the heart.

The study compared two types of surgeries - radical pericardiectomy and sub-total pericardiectomy. In a radical pericardiectomy, the entire pericardium is removed, while in a sub-total pericardiectomy, only a portion of it is removed.

The research found that patients who underwent the radical pericardiectomy had a better survival rate after 10 years (94%) than those who underwent the sub-total pericardiectomy (55%). This was also the case in a subgroup of patients with idiopathic chronic constrictive pericarditis (a type of the disease with an unknown cause).

Furthermore, patients who had the radical pericardiectomy also showed better heart function after the surgery. After 5 years, 85% were in the New York Heart Association (NYHA) functional class I or II (which indicates less severe symptoms) and this increased to 94% after up to 25 years. For the sub-total pericardiectomy group, these figures were lower (53% and 63%, respectively).

In conclusion, the study suggests that radical pericardiectomy provides better long-term survival rates and improved heart function for patients with chronic constrictive pericarditis than sub-total pericardiectomy.

FAQs

  1. What is the impact of radical pericardiectomy on patient survival compared to sub-total pericardiectomy?
  2. How does radical pericardiectomy affect the New York Heart Association (NYHA) functional class and left ventricular ejection fraction in patients?
  3. What are the differences in survival rates between patients who underwent radical pericardiectomy and sub-total pericardiectomy for chronic constrictive pericarditis over a 10-year period?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about pericardiectomy is to consider opting for a radical pericardiectomy over a sub-total pericardiectomy, as it has been shown to result in increased long-term survival rates and improved clinical functional outcomes. This information can help the patient make an informed decision about their treatment options.

Suitable For

Patients with chronic constrictive pericarditis who have failed medical management and are experiencing symptoms such as dyspnea, fatigue, and exercise intolerance are typically recommended for pericardiectomy. Specifically, patients who are suitable candidates for radical pericardiectomy, as opposed to sub-total pericardiectomy, may benefit from improved long-term survival and functional outcomes. Patients with idiopathic chronic constrictive pericarditis may especially benefit from a radical pericardiectomy.

Timeline

Before pericardiectomy:

  • Patients with chronic constrictive pericarditis experience symptoms such as shortness of breath, chest pain, fatigue, and swelling in the abdomen and legs.
  • Diagnostic tests such as echocardiogram, cardiac MRI, and cardiac catheterization are performed to confirm the diagnosis.
  • Treatment options such as medications to manage symptoms and pericardiocentesis (draining fluid from around the heart) may be attempted before surgery is considered.

After pericardiectomy:

  • Patients undergo either sub-total or radical pericardiectomy surgery to remove the thickened and constricting pericardium.
  • Radical pericardiectomy is shown to result in increased long-term survival rates and improved New York Heart Association (NYHA) functional class compared to sub-total pericardiectomy.
  • Patients who undergo radical pericardiectomy have a higher likelihood of being in NYHA functional class I or II after 5 years and up to 25 years post-surgery.
  • Follow-up care includes monitoring for complications, rehabilitation, and ongoing heart health management.

What to Ask Your Doctor

  1. What is the difference between radical pericardiectomy and sub-total pericardiectomy?
  2. What are the potential risks and complications associated with pericardiectomy surgery?
  3. How long is the recovery period after pericardiectomy surgery?
  4. Will I need any follow-up appointments or monitoring after the surgery?
  5. How will pericardiectomy affect my heart function and overall health in the long term?
  6. Are there any lifestyle changes or medications I will need to take after pericardiectomy surgery?
  7. What is the success rate of pericardiectomy surgery for patients with chronic constrictive pericarditis?
  8. Are there any alternative treatment options to consider before opting for pericardiectomy surgery?
  9. How many pericardiectomy surgeries have you performed, and what is your success rate?
  10. Are there any specific instructions or precautions I should follow before and after the surgery?

Reference

Authors: Nozohoor S, Johansson M, Koul B, Cunha-Goncalves D. Journal: J Card Surg. 2018 Jun;33(6):301-307. doi: 10.1111/jocs.13715. Epub 2018 May 14. PMID: 29761570