1. Pericardiectomy for constrictive pericarditis: a risk factor analysis for early and late failure.
- Author
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Gatti G, Fiore A, Ternacle J, Porcari A, Fiorica I, Poletti A, Ecarnot F, Bussani R, Pappalardo A, Chocron S, Folliguet T, and Perrotti A
- Subjects
- Aged, Cardiopulmonary Bypass mortality, Cause of Death, Female, France, Hospital Mortality, Humans, Italy, Male, Middle Aged, Patient Readmission, Pericardiectomy mortality, Pericarditis, Constrictive diagnostic imaging, Pericarditis, Constrictive mortality, Pericarditis, Constrictive physiopathology, Postoperative Complications mortality, Postoperative Complications physiopathology, Postoperative Complications therapy, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Failure, Cardiopulmonary Bypass adverse effects, Pericardiectomy adverse effects, Pericarditis, Constrictive surgery, Postoperative Complications etiology
- Abstract
Predictors of early and late failure of pericardiectomy for constrictive pericarditis (CP) have not been established. Early and late outcomes of a cumulative series of 81 (mean age 60 years; mean EuroSCORE II, 3.3%) consecutive patients from three European cardiac surgery centers were reviewed. Predictors of a combined endpoint comprising in-hospital death or major complications (including multiple transfusion) were identified with binary logistic regression. Non-parametric estimates of survival were obtained with the Kaplan-Meier method. Predictors of poor late outcomes were established using Cox proportional hazard regression. There were 4 (4.9%) in-hospital deaths. Preoperative central venous pressure > 15 mmHg (p = 0.005) and the use of cardiopulmonary bypass (p = 0.016) were independent predictors of complicated in-hospital course, which occurred in 29 (35.8%) patients. During follow-up (median, 5.4 years), preoperative renal impairment was a predictor of all-cause death (p = 0.0041), cardiac death (p = 0.0008), as well as hospital readmission due to congestive heart failure (p = 0.0037); while partial pericardiectomy predicted all-cause death (p = 0.028) and concomitant cardiac operation predicted cardiac death (p = 0.026), postoperative central venous pressure < 10 mmHg was associated with a low risk both of all-cause and cardiac death (p < 0.0001 for both). Ten-year adjusted survival free of all-cause death, cardiac death, and hospital readmission were 76.9%, 94.7%, and 90.6%, respectively. In high-risk patients with CP, performing pericardiectomy before severe constriction develops and avoiding cardiopulmonary bypass (when possible) could contribute to improving immediate outcomes post-surgery. Complete removal of cardiac constriction could enhance long-term outcomes.
- Published
- 2020
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