Vistarini Nicola, Chen Christina, Mazine Amine, Bouchard Denis, Hebert Yves, Carrier Michel, Cartier Raymond, Demers Philippe, Pellerin Michel, Perrault Louis P
Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Pavia University School of Medicine, Pavia, Italy.
Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Ann Thorac Surg. 2015 Jul;100(1):107-13. doi: 10.1016/j.athoracsur.2015.02.054. Epub 2015 May 13.
The aim of this study was to evaluate our single-center experience with pericardiectomy for constrictive pericarditis. The main objectives of our analysis were long-term survival, clinical outcome, and identification of risk factors.
Over a 20-year period, 99 consecutive patients underwent pericardiectomy at the Montreal Heart Institute. The indications for operation were idiopathic pericarditis (61%), postsurgical (13%), infectious (15%), postirradiation (2%), and miscellaneous (9%). Associated procedures were performed in 36% of cases. The duration of symptoms was longer than 6 months in 53% of cases, and two thirds of patients were in New York Heart Association class III or IV.
Hospital mortality was 9% in the whole series and 7.9% in case of isolated pericardiectomy. The patients operated on within 6 months after the onset of symptoms showed a lower risk of mortality. Conversely, preoperative hepatomegaly and concomitant valvular operation were associated with significantly higher mortality on both univariate and multivariate analysis. In cases of isolated pericardiectomy, the outcome was mainly conditioned by associated comorbidities. The long-term survival was satisfactory, and the functional status at follow-up was improved in most cases.
The clinical outcome of pericardiectomy for constrictive pericarditis is still marked by high operative mortality. Nevertheless, surgical treatment is able to improve the functional class in the majority of late survivors. Preoperative clinical conditions and associated comorbidities are crucial in predicting the risk of mortality, and early operation seems to be the most appropriate choice. The most suitable surgical strategy in cases of associated valvular operation remains to be determined.
本研究旨在评估我们在单中心进行缩窄性心包炎心包切除术的经验。我们分析的主要目标是长期生存率、临床结局以及识别危险因素。
在20年期间，蒙特利尔心脏研究所连续99例患者接受了心包切除术。手术指征为特发性心包炎（61%）、术后（13%）、感染性（15%）、放疗后（2%）和其他（9%）。36%的病例进行了相关手术。53%的病例症状持续时间超过6个月，三分之二的患者为纽约心脏协会III或IV级。
整个系列的医院死亡率为9%，单纯心包切除术的死亡率为7.9%。症状出现后6个月内接受手术的患者死亡率较低。相反，术前肝肿大和同期瓣膜手术在单因素和多因素分析中均与显著更高的死亡率相关。在单纯心包切除术的病例中，结局主要取决于相关的合并症。长期生存率令人满意，大多数病例随访时的功能状态得到改善。
缩窄性心包炎心包切除术的临床结局仍以高手术死亡率为特征。然而，手术治疗能够改善大多数晚期幸存者的功能分级。术前临床状况和相关合并症对于预测死亡风险至关重要，早期手术似乎是最合适的选择。同期瓣膜手术病例中最合适的手术策略仍有待确定。
