The Thoracic and cardiovascular surgeon · 2026
Eleven-Year Experience and Early Outcomes of Pericardiectomy for Constrictive Pericarditis.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Gaisendrees Christopher, Djordjevic Llija, Schlachtenberger Geor, Walter Sebastian, Gerfer Stephen
Аннотация
BACKGROUND: Constrictive pericarditis represents the end stage of chronic pericardial inflammation and is characterized by impaired diastolic filling due to pericardial fibrosis and/or calcification, leading to progressive right-sided heart failure. Pericardiectomy remains the definitive treatment, yet perioperative risk remains substantial in patients with advanced disease.
METHODS: We performed a retrospective single-center cohort study of 47 consecutive patients undergoing surgical pericardiectomy for constrictive pericarditis between January 2010 and December 2021. Perioperative characteristics, operative strategy, and early outcomes, including 30-day mortality, postoperative morbidity, and length of stay, were assessed.
RESULTS: Mean age was 58 ± 14 years, and 64% of patients were male (n = 30). In the study 65% of patients presented with NYHA functional class III to IV, and operative risk was elevated, with a mean EuroSCORE II of 8.5 ± 2.3 and a mean STS score of 9.4 ± 2.3. Median sternotomy was used in 94% of patients (n = 44), radical pericardiectomy in 64% (n = 30), and a beating-heart strategy without cardiopulmonary bypass in 79% (n = 37), whereas cardiopulmonary bypass was required in 21% (n = 10). We found 30-day all-cause mortality was 6% (n = 3). Major postoperative complications included sepsis in 13% (n = 6) and renal failure requiring dialysis in 8.5% (n = 4). Mean ICU stay was 3.7 ± 4.5 days, and mean total hospital stay was 11 ± 6.7 days.
CONCLUSION: Pericardiectomy for constrictive pericarditis can be performed with acceptable early mortality and morbidity even in a high-risk population. In experienced centers, an individualized surgical strategy prioritizing extensive pericardial resection with selective use of cardiopulmonary bypass appears feasible for the management of advanced disease.
METHODS: We performed a retrospective single-center cohort study of 47 consecutive patients undergoing surgical pericardiectomy for constrictive pericarditis between January 2010 and December 2021. Perioperative characteristics, operative strategy, and early outcomes, including 30-day mortality, postoperative morbidity, and length of stay, were assessed.
RESULTS: Mean age was 58 ± 14 years, and 64% of patients were male (n = 30). In the study 65% of patients presented with NYHA functional class III to IV, and operative risk was elevated, with a mean EuroSCORE II of 8.5 ± 2.3 and a mean STS score of 9.4 ± 2.3. Median sternotomy was used in 94% of patients (n = 44), radical pericardiectomy in 64% (n = 30), and a beating-heart strategy without cardiopulmonary bypass in 79% (n = 37), whereas cardiopulmonary bypass was required in 21% (n = 10). We found 30-day all-cause mortality was 6% (n = 3). Major postoperative complications included sepsis in 13% (n = 6) and renal failure requiring dialysis in 8.5% (n = 4). Mean ICU stay was 3.7 ± 4.5 days, and mean total hospital stay was 11 ± 6.7 days.
CONCLUSION: Pericardiectomy for constrictive pericarditis can be performed with acceptable early mortality and morbidity even in a high-risk population. In experienced centers, an individualized surgical strategy prioritizing extensive pericardial resection with selective use of cardiopulmonary bypass appears feasible for the management of advanced disease.