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Effectiveness and long-term outcomes of surgical intervention for constrictive epicardium in constrictive pericarditis

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Abstract

Objective

Epicardial resection is considered effective in patients with constrictive pericarditis accompanied by epicardial constriction, but few publications have evaluated its long-term outcomes. The study objective was to evaluate early and late results of epicardial resection.

Methods

A total of 22 patients with pericardiectomy for constrictive pericarditis were treated at our institution between 1989 and 2016. They were stratified by the presence or absence of constrictive epicardium and the surgical intervention performed. Group A (n = 7) included those with constrictive epicardium and epicardial resection in addition to pericardiectomy. Group B (n = 5) included those with constrictive epicardium and single pericardiectomy. Group C (n = 10) included those without constrictive epicardium and with a single pericardiectomy. Postsurgical changes were evaluated by echocardiography.

Results

No significant differences were found in preoperative baseline characteristics, operative details, and operative mortality among the groups. The median postoperative follow-up was 80 months. Group A patients did not experience cardiac events, and left ventricular end-diastolic volume and stroke volume were significantly improved at late follow-up compared with before and soon after surgery. The early postsurgical parameters were significantly improved in Group C patients, but the improvements were attenuated on late follow-up. Group B patients had the highest occurrence of cardiac events and no improvement in echocardiographic parameters.

Conclusion

Surgical intervention in constrictive epicardium improved echocardiographic parameters and was free of cardiac events during long-term follow-up.

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References

  1. Kouchoukos NT, Blackstone EH, Hanley FL, Kirklin JK. Pericardial disease. Kirklin/Barrat-Boyes cardiac surgery. 4th ed. Philadelphia: Elsevier Saunders; 2013. pp. 900–15.

    Google Scholar 

  2. Ling LH, Oh JK, Schaff HV, Danielson GK, Mahoney DW, Seward JB, et al. Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardiectomy. Circulation. 1999;100:1380–6.

    Article  CAS  PubMed  Google Scholar 

  3. Bertog SC, Thambidorai SK, Parakh K, Schoenhagen P, Ozduran V, Houghtaling PL, et al. Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy. J Am Coll Cardiol. 2004;43:1445–52.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Vistarini N, Chen C, Mazine A, Bouchard D, Hebert Y, Carrier M, et al. Pericardiectomy for constrictive pericarditis: 20 years of experience at the montreal heart institute. Ann Thorac Surg. 2015;100:107–13.

    Article  PubMed  Google Scholar 

  6. Gillaspie EA, Stulak JM, Daly RC, Greason KL, Joyce LD, Oh J, et al. A 20-year experience with isolated pericardiectomy: analysis of indications and outcomes. J Thorac Cardiovasc Surg. 2016;152:448–58.

    Article  PubMed  Google Scholar 

  7. Walsh TJ, Baughman KL, Gardner TJ, Bulkley BH. Constrictive epicarditis as a cause of delayed or absent response to pericardiectomy: a clinicopathological study. J Thorac Cardiovasc Surg. 1982;83:126–32.

    CAS  PubMed  Google Scholar 

  8. Heimbecker RO, Smith D, Shimizu S, Kestle J. Surgical technique for the management of constrictive epicarditis complicating constrictive pericarditis (the waffle procedure). Ann Thorac Surg. 1983;36:605–6.

    Article  CAS  PubMed  Google Scholar 

  9. Faggian G, Mazzucco A, Tursi V, Bortolotti U, Gallucci V. Constrictive epicarditis after open heart surgery: the turtle cage operation. J Card Surg. 1990;5:318–20.

    Article  CAS  PubMed  Google Scholar 

  10. Shiraishi M, Yamaguchi A, Muramatsu K, Kimura N, Yuri K, Matsumoto H, et al. Validation of Waffle procedure for constrictive pericarditis with epicardial thickening. Gen Thorac Cardiovasc Surg. 2015;63:30–7.

    Article  PubMed  Google Scholar 

  11. Levine HD. Myocardial fibrosis in constrictive pericarditis. Electrocardiographic and pathologic observations. Circulation. 1973;48:1268–81.

    Article  CAS  PubMed  Google Scholar 

  12. Masuda M, Okumura M, Doki Y, Endo S, Hirata Y, Kobayashi J, et al. Thoracic and cardiovascular surgery in Japan during 2014: annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2016;64:665–97.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Szabó G, Schmack B, Bulut C, Soós P, Weymann A, Stadtfeld S, et al. Constrictive pericarditis: risks, aetiologies and outcomes after total pericardiectomy: 24 years of experience. Eur J Cardiothorac Surg. 2013;44:1023–8.

    Article  PubMed  Google Scholar 

  14. Busch C, Penov K, Amorim PA, Garbade J, Davierwala P, Schuler GC, et al. Risk factors for mortality after pericardiectomy for chronic constrictive pericarditis in a large single-centre cohort. Eur J Cardiothorac Surg. 2015;48:e110-6.

    PubMed  Google Scholar 

  15. Tokuda Y, Miyata H, Motomura N, Araki Y, Oshima H, Usui A, et al. Japan adult cardiovascular database organization. Outcome of pericardiectomy for constrictive pericarditis in Japan: a nationwide outcome study. Ann Thorac Surg. 2013;96:571–6.

    Article  PubMed  Google Scholar 

  16. Komoda T, Frumkin A, Knosalla C, Hetzer R. Child-Pugh score predicts survival after radical pericardiectomy for constrictive pericarditis. Ann Thorac Surg. 2013;96:1679–85.

    Article  PubMed  Google Scholar 

  17. Ariyoshi T, Hashizume K, Taniguchi S, Miura T, Tanigawa K, Matsukuma S, et al. Surgical experience with chronic constrictive pericarditis. Gen Thorac Cardiovasc Surg. 2012;60:796–802.

    Article  PubMed  Google Scholar 

  18. Raghunathan D, Khilji MI, Hassan SA, Yusuf SW. Radiation-induced cardiovascular disease. Curr Atheroscler Rep. 2017;19:22.

    Article  PubMed  Google Scholar 

  19. Cho YH, Schaff HV, Dearani JA, Daly RC, Park SJ, Li Z, et al. Completion pericardiectomy for recurrent constrictive pericarditis: importance of timing of recurrence on late clinical outcome of operation. Ann Thorac Surg. 2012;93:1236–40.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiac Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Yangsin Lee

  2. Department of Cardiovascular Surgery, Cardiovascular Center, Toranomon Hospital, Tokyo, Japan

    Yangsin Lee, Yoshihiro Naruse & Keita Tanaka

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  1. Yangsin Lee
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  2. Yoshihiro Naruse
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Correspondence to Yangsin Lee.

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Lee, Y., Naruse, Y. & Tanaka, K. Effectiveness and long-term outcomes of surgical intervention for constrictive epicardium in constrictive pericarditis. Gen Thorac Cardiovasc Surg 66, 137–144 (2018). https://doi.org/10.1007/s11748-017-0854-1

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  • DOI: https://doi.org/10.1007/s11748-017-0854-1

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