Our Summary

This research paper looks at why some patients have complications after surgery for a heart condition called constrictive pericarditis (CP). This condition happens when the sac-like covering around the heart (pericardium) becomes rigid and can’t move properly, which can affect how the heart works. The surgery to treat this, called a pericardiectomy, involves removing part or all of the pericardium.

The researchers reviewed the records of 81 patients who had this surgery across three European heart surgery centers. They looked at factors that could predict problems both during their hospital stay and after they went home.

They found that patients who had a high level of pressure in the veins around their heart before surgery, and those who needed a machine to do the job of their heart and lungs during surgery (cardiopulmonary bypass), were more likely to have complications while in the hospital.

In the longer term, patients who had kidney problems before surgery were more likely to die from any cause, die from heart-related issues, or be readmitted to the hospital because their heart wasn’t pumping blood properly. Patients who only had part of their pericardium removed or had another heart surgery at the same time were also more likely to die.

On the other hand, patients who had a low level of pressure in the veins around their heart after surgery were less likely to die from any cause or from heart-related issues.

The researchers concluded that for high-risk patients with CP, having the pericardiectomy before the constriction gets severe and avoiding the use of the bypass machine, if possible, could improve their chances of recovering well from the surgery. They also suggested that completely removing the pericardium could lead to better long-term results.

FAQs

  1. What are the predictors of early and late failure of pericardiectomy for constrictive pericarditis?
  2. How does preoperative renal impairment affect the outcomes of pericardiectomy?
  3. What strategies could improve immediate and long-term outcomes post-pericardiectomy in high-risk patients with constrictive pericarditis?

Doctor’s Tip

One helpful tip a doctor might tell a patient about pericardiectomy is to have the procedure done before severe constriction develops, as this could improve immediate outcomes post-surgery. Additionally, avoiding the use of cardiopulmonary bypass when possible may also contribute to better outcomes. Complete removal of cardiac constriction during the surgery could enhance long-term outcomes as well.

Suitable For

Patients with constrictive pericarditis, especially those with preoperative central venous pressure > 15 mmHg, renal impairment, and those who may benefit from avoiding cardiopulmonary bypass, are typically recommended for pericardiectomy. Patients who have severe constriction and are at high risk for complications may also benefit from early surgical intervention to improve immediate outcomes post-surgery and enhance long-term outcomes. It is important for clinicians to carefully evaluate each patient’s individual risk factors and consider the potential benefits of pericardiectomy in order to make appropriate recommendations for surgery.

Timeline

  • Pre-pericardiectomy: Patients may experience symptoms such as shortness of breath, chest pain, fatigue, and swelling in the legs. They may undergo diagnostic tests such as echocardiograms, CT scans, and cardiac catheterization to confirm the diagnosis of constrictive pericarditis. The decision to undergo pericardiectomy is made based on the severity of symptoms and the presence of complications.

  • Pericardiectomy surgery: The surgical procedure involves removing part or all of the pericardium to relieve constriction of the heart. The surgery may be performed using cardiopulmonary bypass, depending on the patient’s condition. After the surgery, patients are monitored in the intensive care unit for complications such as bleeding, infection, and heart rhythm disturbances.

  • Post-pericardiectomy: Patients may experience a period of recovery in the hospital, which may involve physical therapy, medication management, and monitoring for complications. They may gradually experience improvement in symptoms such as improved exercise tolerance, reduced shortness of breath, and decreased swelling. Long-term follow-up is important to monitor for any recurrence of symptoms or complications.

Overall, the goal of pericardiectomy is to improve the patient’s quality of life and long-term outcomes by relieving the constriction of the heart caused by constrictive pericarditis.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with pericardiectomy?
  2. How will my recovery process look like after the surgery?
  3. Will I need any additional treatments or medications post-surgery?
  4. What are the success rates of pericardiectomy for patients with constrictive pericarditis?
  5. How long will it take for me to fully recover and resume normal activities?
  6. Are there any specific lifestyle changes I should make to improve my outcomes post-surgery?
  7. What follow-up appointments or tests will be necessary to monitor my progress after the surgery?
  8. Are there any specific warning signs or symptoms I should watch out for after the surgery?
  9. How experienced are you and your team in performing pericardiectomy procedures?
  10. Can you provide me with any patient testimonials or success stories from previous pericardiectomy patients?

Reference

Authors: Gatti G, Fiore A, Ternacle J, Porcari A, Fiorica I, Poletti A, Ecarnot F, Bussani R, Pappalardo A, Chocron S, Folliguet T, Perrotti A. Journal: Heart Vessels. 2020 Jan;35(1):92-103. doi: 10.1007/s00380-019-01464-4. Epub 2019 Jun 24. PMID: 31236676