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Pericardiectomy for constrictive pericarditis at a single Japanese center: 20 years of experience

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Abstract

Objective

Constrictive pericarditis (CP) is a rare disease, and the diagnosis and surgical treatment of CP remain challenging. The aim of this study was to evaluate our Japanese single-center experience with isolated pericardiectomy for CP to elucidate the factors associated with improved outcomes.

Methods

Over a 20-year period, 44 consecutive patients underwent isolated pericardiectomy at our institution. The cause of CP was: idiopathic (59%), postsurgical (32%), tuberculosis (7%), and postradiation (2%) of the patients. All patients were diagnosed with CP using multiple modalities, including echocardiography, cardiac catheterization, computed tomography, or magnetic resonance imaging (MRI). Median sternotomy was performed in 42 (95%) patients. Twenty-eight (68%) patients underwent radical pericardiectomy.

Results

The postoperative diagnosis in all patients was CP. Among the multiple modalities, cardiac MRI had the greatest diagnostic sensitivity (97.2%). There were no operative or hospital deaths; late mortality occurred in seven (15.9%) patients in the series. Multivariable analysis showed that preoperative low LVEF was a risk factor for long-term mortality. Seven patients were readmitted for heart failure postoperatively. Multivariable analysis showed incomplete pericardiectomy and use of a preoperative inotrope were risk factors for readmission for heart failure.

Conclusions

The diagnosis using multimodality imaging for CP was effective in our institution and tagged cine MRI had the greatest sensitivity in diagnosing CP. Preoperative condition, including preoperative low LVEF or inotrope use, was correlated with long-term outcome after pericardiectomy. Pericardiectomy should be performed early and as radically as possible to prevent recurrent heart failure.

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References

  1. Myers RB, Spodick DH. Constrictive pericarditis: clinical and pathophysiologic characteristics. Am Heart J. 1999;138(2 Pt 1):219–32.

    Article  CAS  PubMed  Google Scholar 

  2. Syed FF, Schaff HV, Oh JK. Constrictive pericarditis—a curable diastolic heart failure. Nat Rev Cardiol. 2014;11:530–44.

    Article  PubMed  Google Scholar 

  3. Nataf P, Cacoub P, Dorent R, Jault F, Bors V, Pavie A, et al. Results of subtotal pericardiectomy for constrictive pericarditis. Eur J Cardiothorac Surg. 1993;7:252–6.

    Article  CAS  PubMed  Google Scholar 

  4. Kojima S, Yamada N, Goto Y. Diagnosis of constrictive pericarditis by tagged cine magnetic resonance imaging. N Engl J Med. 1999;341:373–4.

    Article  CAS  PubMed  Google Scholar 

  5. Power JA, Thompson DV, Rayarao G, Doyle M, Biederman RWW. Cardiac magnetic resonance radiofrequency tissue tagging for diagnosis of constrictive pericarditis: A proof of concept study. J Thorac Cardiovasc Surg. 2016;151:1348–55.

    Article  PubMed  Google Scholar 

  6. Amaki M, Savino J, Ain DL, Sanz J, Pedrizzetti GP, Kulkarni H, Narula J, Sengupta PP. Diagnostic Concordance of Echocardiography and Cardiac Magnetic Resonance–Based Tissue Tracking for Differentiating Constrictive Pericarditis From Restrictive Cardiomyopathy. Circulation: Cardiovascular Imag 2014; 7: 819–27.

  7. McCaughan BC, Schaff HV, Piehler JM, Danielson GK, Orszulak TA, Puga FJ, et al. Early and late results of pericardiectomy for constrictive pericarditis. J Thorac Cardiovasc Surg. 1985;89:340–50.

    Article  CAS  PubMed  Google Scholar 

  8. Cameron J, Oesterle SN, Baldwin JC, Hancock EW. The etiologic spectrum of constrictive pericarditis. Am Heart J. 1987;113(2 Pt 1):354–60.

    Article  CAS  PubMed  Google Scholar 

  9. DeValeria PA, Baumgartner WA, Casale AS, Greene PS, Cameron DE, Gardner TJ, et al. Current indications, risks, and outcome after pericardiectomy. Ann Thorac Surg. 1991;52:219–24.

    Article  CAS  PubMed  Google Scholar 

  10. 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 

  11. Arsan S, Mercan S, Sarigül A, Atasoy S, Demircin M, Dogan R, et al. Long-term experience with pericardiectomy: analysis of 105 consecutive patients. Thorac Cardiovasc Surg. 1994;42:340–4.

    Article  CAS  PubMed  Google Scholar 

  12. Chowdhury UK, Subramaniam GK, Kumar AS, Airan B, Singh R, Talwar S, et al. Pericardiectomy for constrictive pericarditis: a clinical, echocardiographic, and hemodynamic evaluation of two surgical techniques. Ann Thorac Surg. 2006;81:522–9.

    Article  PubMed  Google Scholar 

  13. Bozbuga N, Erentug V, Eren E, Erdogan HB, Kirali K, Antal A, et al. Pericardiectomy for chronic constrictive tuberculous pericarditis: risks and predictors of survival. Tex Heart Inst J. 2003;30:180–5.

    PubMed  PubMed Central  Google Scholar 

  14. Cho YH, Schaff HV. Surgery for pericardial disease. Heart Fail Rev. 2013;18:375–87.

    Article  PubMed  Google Scholar 

  15. Szabo 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 

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

    Article  PubMed  Google Scholar 

  17. Ling LH, Oh JK, Schaff HV, Danielson GK, Mahoney DW, Seward JB, et al. Constrictive Pericarditis in the Modern Ara: Evolving Clinical Spectrum and Impact on Outcome After Pericardiectomy. Circulation. 1999;100:1380–6.

    Article  CAS  PubMed  Google Scholar 

  18. 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 

  19. 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 

  20. Avgerinos D, Rabitnokov Y, Worku B, Neragi-Miandoab S, Girardi LN. Fifteen-year experience and outcomes of pericardiectomy for constrictive pericarditis. J Card Surg. 2014;29:434–8.

    Article  PubMed  Google Scholar 

  21. Góngora E, Dearani JA, Orszulak TA, Schaff HV, Li Z, Sundt TM 3rd. Tricuspid regurgitation in patients undergoing pericardiectomy for constrictive pericarditis. Ann Thorac Surg. 2008;85:163–71.

    Article  PubMed  Google Scholar 

  22. Kuroda H, Sakaguchi M, Takano T, Tsunemoto H, Shinohara M, Fukaya Y, et al. Intraoperative monitoring of pressure-volume loops of the left ventricle in pericardectomy for constrictive pericarditis. J Thorac Cardiovasc Surg. 1996;112:198–9.

    Article  CAS  PubMed  Google Scholar 

  23. Imagawa H, Ishikawa K. Images in cardiovascular medicine. Fading out dip-and-plateau pattern of right ventricular pressure in constrictive pericarditis. Circulation. 2010;122:404–5.

    Article  PubMed  Google Scholar 

  24. 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 

  25. Kang SH, Song J-M, Kim M, Choo SJ, Chung CH, Kang D-H, et al. Prognostic predictors in pericardiectomy for chronic constrictive pericarditis. J Thorac Cardiovasc Surg. 2014;147:598–605.

    Article  PubMed  Google Scholar 

  26. Ha J-W, Oh JK, Schaff HV, Ling LH, Higano ST, Mahoney DW, et al. Impact of left ventricular function on immediate and long-term outcomes after pericardiectomy in constrictive pericarditis. J Thorac Cardiovasc Surg. 2008;136:1136–41.

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Andrea Baird, MD, from Edanz Group (https://jp.edanz.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan

    Tetsuya Saito, Satsuki Fukushima, Takuma Yamasaki, Naonori Kawamoto, Naoki Tadokoro, Takashi Kakuta, Ayumi Ikuta & Tomoyuki Fujita

  2. Department of Surgical Intensive Care, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan

    Kimito Minami

  3. Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan

    Yasutoshi Ohta

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  1. Tetsuya Saito
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Correspondence to Satsuki Fukushima.

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Saito, T., Fukushima, S., Yamasaki, T. et al. Pericardiectomy for constrictive pericarditis at a single Japanese center: 20 years of experience. Gen Thorac Cardiovasc Surg 70, 430–438 (2022). https://doi.org/10.1007/s11748-021-01718-x

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