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The Importance of Complete Pericardiectomy and the Role of the Apical Suction Device in Chronic Constrictive Pericarditis

  • Kim, Sang Yoon (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Na, Kwon Joong (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Kim, Kyung-Hwan (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital)
  • Received : 2016.06.02
  • Accepted : 2016.09.12
  • Published : 2017.02.05

Abstract

Background: The aim of this study was to analyze the preoperative attributes and clinical impacts of complete pericardiectomy in chronic constrictive pericarditis. Methods: A total of 26 patients were treated from January 2001 to December 2013. The pericardium was resected as widely as possible. When excessive bleeding or hemodynamic instability occurred intraoperatively, a cardiopulmonary bypass (CPB; n=3, 11.5%) or an apical suction device (n=8, 30.8%) was used. Patients were divided into 2 groups: those who underwent ${\geq}80%$ resection of the pericardium (group A, n=18) and those who underwent <80% resection of the pericardium (group B, n=8). Results: The frequency of CPB use was not significantly different between groups A and B (n=2, 11.1% vs. n=1, 12.5%; p=1.000). However, the apical suction device was more frequently applied in group A than group B (n=8, 30.8% vs. n=0, 0.0%; p=0.031). The postoperative New York Heart Association functional classification improved more in group A (p=0.030). Long-term follow-up echocardiography also showed a lower frequency of unresolved constriction in group A than in group B (n=1, 5.60% vs. n=5, 62.5%; p=0.008). Conclusion: Patients with chronic constrictive pericarditis demonstrated symptomatic improvement through complete pericardiectomy. Aggressive resection of the pericardium may correct constrictive physiology and an apical suction device can facilitate the approach to the posterolateral aspect of the left ventricle and atrioventricular groove area without the aid of CPB.

Keywords

References

  1. Chowdhury UK, Subramaniam GK, Kumar AS, et al. Pericardiectomy for constrictive pericarditis: a clinical, echocardiographic, and hemodynamic evaluation of two surgical techniques. Ann Thorac Surg 2006;81:522-9. https://doi.org/10.1016/j.athoracsur.2005.08.009
  2. Schwefer M, Aschenbach R, Heidemann J, Mey C, Lapp H. Constrictive pericarditis, still a diagnostic challenge: comprehensive review of clinical management. Eur J Cardiothorac Surg 2009;36:502-10. https://doi.org/10.1016/j.ejcts.2009.03.004
  3. George TJ, Arnaoutakis GJ, Beaty CA, Kilic A, Baumgartner WA, Conte JV. Contemporary etiologies, risk factors, and outcomes after pericardiectomy. Ann Thorac Surg 2012; 94:445-51. https://doi.org/10.1016/j.athoracsur.2012.03.079
  4. Szabo G, Schmack B, Bulut C, et al. Constrictive pericarditis: risks, aetiologies and outcomes after total pericardiectomy: 24 years of experience. Eur J Cardiothorac Surg 2013;44:1023-8. https://doi.org/10.1093/ejcts/ezt138
  5. Hanneman K, Thavendiranathan P, Nguyen ET, et al. Cardiovascular CT in the diagnosis of pericardial constriction: predictive value of inferior vena cava cross-sectional area. J Cardiovasc Comput Tomogr 2014;8:149-57. https://doi.org/10.1016/j.jcct.2013.12.017
  6. Suh SY, Rha SW, Kim JW, et al. The usefulness of three-dimensional multidetector computed tomography to delineate pericardial calcification in constrictive pericarditis. Int J Cardiol 2006;113:414-6. https://doi.org/10.1016/j.ijcard.2005.09.044
  7. Rajiah P, Kanne JP. Computed tomography of the pericardium and pericardial disease. J Cardiovasc Comput Tomogr 2010;4:3-18. https://doi.org/10.1016/j.jcct.2010.01.004
  8. Klein AL, Abbara S, Agler DA, et al. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2013;26:965-1012.e15. https://doi.org/10.1016/j.echo.2013.06.023
  9. Kameda Y, Funabashi N, Kawakubo M, et al. Heart in an eggshell: eggshell appearance calcified constrictive pericarditis demonstrated by three-dimensional images of multislice computed tomography. Int J Cardiol 2007;120: 269-72. https://doi.org/10.1016/j.ijcard.2006.07.188
  10. Gaudino M, Anselmi A, Pavone N, Massetti M. Constrictive pericarditis after cardiac surgery. Ann Thorac Surg 2013; 95:731-6. https://doi.org/10.1016/j.athoracsur.2012.08.059
  11. Nataf P, Cacoub P, Dorent R, et al. Results of subtotal pericardiectomy for constrictive pericarditis. Eur J Cardiothorac Surg 1993;7:252-5. https://doi.org/10.1016/1010-7940(93)90213-U
  12. Bertog SC, Thambidorai SK, Parakh K, et al. Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy. J Am Coll Cardiol 2004;43:1445-52. https://doi.org/10.1016/j.jacc.2003.11.048
  13. McCaughan BC, Schaff HV, Piehler JM, et al. Early and late results of pericardiectomy for constrictive pericarditis. J Thorac Cardiovasc Surg 1985;89:340-50.
  14. Copeland JG, Stinson EB, Griepp RB, Shumway NE. Surgical treatment of chronic constrictive pericarditis using cardiopulmonary bypass. J Thorac Cardiovasc Surg 1975;69:236-8.
  15. Tokuda Y, Miyata H, Motomura N, et al. Outcome of pericardiectomy for constrictive pericarditis in Japan: a nationwide outcome study. Ann Thorac Surg 2013;96:571-6. https://doi.org/10.1016/j.athoracsur.2013.04.054
  16. Athanasiou T, Kumar P, Al-Ruzzeh S, et al. Expanded use of suction and stabilization devices in cardiothoracic surgery. Ann Thorac Surg 2003;76:1126-30. https://doi.org/10.1016/S0003-4975(03)00815-4
  17. Fukumoto A, Yamagishi M, Doi K, Ogawa M, Inoue T, Yaku H. Off-pump pericardiectomy using an ultrasonic scalpel and a heart positioner. Asian Cardiovasc Thorac Ann 2007;15:e69-71. https://doi.org/10.1177/021849230701500627
  18. Kang SH, Song JM, Kim M, et al. Prognostic predictors in pericardiectomy for chronic constrictive pericarditis. J Thorac Cardiovasc Surg 2014;147:598-605. https://doi.org/10.1016/j.jtcvs.2013.01.022
  19. Ling LH, Oh JK, Schaff HV, et al. Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardiectomy. Circulation 1999;100:1380-6. https://doi.org/10.1161/01.CIR.100.13.1380

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