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Validation of Waffle procedure for constrictive pericarditis with epicardial thickening

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Abstract

Objective

Waffle procedure, a small grid-like incision of epicardium, is a surgical technique for constrictive pericarditis with epicardial thickening. Yet evidences to endorse this approach for improved outcomes are lacking. The aim of this study is to elucidate better surgical treatment strategy for constrictive pericarditis with epicardial thickening.

Methods

Twenty-five patients (mean 64.1 years) who underwent pericardiectomy for constrictive pericarditis between January 1992 and July 2012 were included in this study and were classified into two groups according to the procedure they received; single total pericardiectomy (Group A, n = 17) and total pericardiectomy with the Waffle procedure (Group B, n = 8). Early and mid-term outcomes were analyzed for each group.

Results

No major postoperative complications or all-cause deaths at 30 days were observed in each group. Upon discharge, postoperative echocardiography showed statistically significant increase of left ventricular end-diastolic volume (from 76.6 ± 30.3 to 91.0 ± 27.3 ml; p < 0.02) and systolic volume (from 44.4 ± 19.1 to 54.5 ± 17.3 ml; p < 0.05) in Group B than those in Group A. The 5-year cardiac event-free rate was similar between groups [83.6 ± 10.8 % for group A and 83.3 ± 15.2 % for group B (p = NS)] as well as the mean value of NYHA classification for each at the mid-term periods (1.5 for Group A and 1.3 for Group B).

Conclusion

Waffle procedure improved echocardiographic elements of diastolic function of patients with epicardial thickening more than did total pericardiectomy without additional compromises.

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Acknowledgments

No external funding was obtained for the work presented here.

Conflict of interest

The authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-Ku, Saitama, 330-8503, Japan

    Manabu Shiraishi, Atsushi Yamaguchi, Naoyuki Kimura, Koichi Yuri, Harunobu Matsumoto, Kouichi Adachi & Hideo Adachi

  2. Division of Cardiovascular Internal Medicine, Saitama Red-cross Hospital, 8-3-33 Kamiochiai, Chyuo-ku, Saitama, 338-8553, Japan

    Kenichi Muramatsu

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  1. Manabu Shiraishi
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  2. Atsushi Yamaguchi
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  3. Kenichi Muramatsu
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  4. Naoyuki Kimura
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  5. Koichi Yuri
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  7. Kouichi Adachi
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  8. Hideo Adachi
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Correspondence to Manabu Shiraishi.

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Shiraishi, M., Yamaguchi, A., Muramatsu, K. et al. Validation of Waffle procedure for constrictive pericarditis with epicardial thickening. Gen Thorac Cardiovasc Surg 63, 30–37 (2015). https://doi.org/10.1007/s11748-014-0434-6

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  • DOI: https://doi.org/10.1007/s11748-014-0434-6

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