Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts.
Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Am J Cardiol. 2021 May 1;146:120-127. doi: 10.1016/j.amjcard.2021.01.033. Epub 2021 Feb 1.
We sought to systematically describe the epidemiology, etiology, clinical and operative characteristics as well as outcomes of patients who underwent pericardiectomy for constrictive pericarditis in the contemporary era. We conducted a systematic search of the MEDLINE, Embase, and Cochrane databases from their inception to April 1, 2020 for studies assessing the outcomes of pericardiectomy in patients with constrictive pericarditis. Studies with patients enrolled before 1985, pediatric patients or studies including >10% tuberculous pericarditis were excluded. The impact of pericarditis etiology on outcomes was evaluated with a meta-analysis. We analyzed 27 eligible studies and 2,114 patients. Etiology was most commonly idiopathic (50.2%), followed by after-cardiac surgery (26.2%) and radiation (6.9%). Patients were mostly men (76%), mean age 58 and with advanced symptoms (NYHA III/IV 70.1%). Total pericardiectomy was preferred (85.8%) and concomitant cardiac surgery was relatively common (23.8%). Operative mortality was 6.9% and 5-year mortality was 32.7%. Radiation and after-cardiac surgery patients had 3 and 2 times higher long-term risk for mortality respectively compared with idiopathic. A sensitivity analysis did not result in changes in the results. Thirty percent of included studies had more than low bias primarily originating from follow up and selection. Pericardiectomy is therefore performed mostly in middle-aged men with advanced symptoms and low co-morbidity burden and still caries significant operative mortality. Radiation and after-cardiac surgery patients have a significantly higher mortality risk compared with idiopathic. Several methodological issues and significant heterogeneity limit the generalization of these data and randomized controlled trials may have to be considered.
我们旨在系统地描述缩窄性心包炎患者行心包切除术的流行病学、病因、临床和手术特征以及结局。我们对 MEDLINE、Embase 和 Cochrane 数据库进行了系统检索，检索时间从建库至 2020 年 4 月 1 日，以评估缩窄性心包炎患者心包切除术结局的研究。排除了 1985 年以前入组的患者、儿科患者或包含超过 10%结核性心包炎的研究。meta 分析评估了心包炎病因对结局的影响。我们分析了 27 项符合条件的研究和 2114 例患者。病因最常见的是特发性（50.2%），其次是心脏手术后（26.2%）和放疗（6.9%）。患者主要为男性（76%），平均年龄 58 岁，症状严重（NYHA III/IV 70.1%）。大多数患者行全心包切除术（85.8%），同期行心脏手术较为常见（23.8%）。手术死亡率为 6.9%，5 年死亡率为 32.7%。与特发性相比，放疗和心脏手术后患者的长期死亡风险分别高 3 倍和 2 倍。敏感性分析结果无变化。30%的纳入研究存在较高偏倚，主要来源于随访和选择。因此，心包切除术主要用于中老年人，症状严重且合并症负担低，但仍存在较高的手术死亡率。与特发性相比，放疗和心脏手术后患者的死亡率明显更高。一些方法学问题和显著的异质性限制了这些数据的推广，可能需要考虑进行随机对照试验。
